Presurgical Succinate MetAstatic Risk Tool (P-SMART) in Paragangliomas.

Area of Science:

• Endocrinology
• Oncology
• Biochemistry

Background:

• Paragangliomas (PGLs) are rare neuroendocrine tumors with unpredictable metastatic potential.
• Current diagnostic methods lack reliable predictors for metastatic risk.
• Genetic factors significantly influence PGL development and behavior.

Purpose of the Study:

• To investigate serum succinate as a biomarker for metastatic risk in PGLs.
• To develop and validate a novel preoperative risk assessment tool for PGL metastasis.

Main Methods:

• Retrospective analysis of 70 PGL patients.
• Collection of clinical, biochemical, imaging, and genetic data.
• Quantification of serum succinate using gas chromatography-mass spectrometry.
• Analysis of germline genetic variants via Sanger sequencing or NGS.

Main Results:

• Higher serum succinate levels correlated with Cluster 1 genetic variants, extra-adrenal PGLs, and metastatic disease.
• Development of the P-SMART tool integrating serum succinate, tumor size, and location.
• P-SMART demonstrated superior predictive performance for metastatic disease compared to the ASES score.

Conclusions:

• Serum succinate shows promise as a minimally invasive biomarker for PGL metastatic risk stratification.
• The P-SMART tool can enhance preoperative risk assessment and clinical decision-making.
• Further prospective studies are needed to validate P-SMART's clinical utility and optimize patient management.