Review Article
Aaron I. Vinik, MD, PhD, FCP, MACP, FACE ABSTRACT Objective: To review the current state of pancreatic neuroendocrine tumors (PNETS) Methods: The literature published between 2005 and 2014 in PUBMED, Medline, Google Scholar, Cochrane reports, and ClinicalTrials.gov was examined for relevance to the topic. Results: PNETS have an incidence 500 pmol/L is an independent indicator of poor outcome. This marker is also known to correlate with the number of liver metastases, so it would be appropriate to use it in the follow-up of NET patients. Furthermore, Stronge et al reported that an increase in pancreastatin levels following SST analog (SSA) therapy was associated with poor survival (31). Other studies have shown that pancreastatin should be measured prior to treatment and monitored during and after it. Plasma levels of this marker above 5,000 pg/mL pretreatment were associated with increased periprocedure mortality in patients with NETs who underwent hepatic artery chemoembolization (32). These observations suggest that pancreastatin is potentially a very useful marker for both diagnosis and monitoring treatment response. Neurokinin A (NKA) has been shown to have strong prognostic value. In 2006, Turner et al showed that patients with midgut carcinoid who had raised plasma NKA but reduced levels after SSA therapy had an 87% survival rate at 1 year compared with 40% in patients in whom the NKA level increased. They also concluded that any alteration in
NKA predicts improved or worsening survival (33). Bone alkaline phosphatase, an indicator of osteoblast function, and urinary N-terminal telopeptide (N-telopeptide), which reflects osteoclast activity or bone resorption, are useful for identifying bone metastases. Metastases from NETs can be either lytic and/or osteoblastic. Somewhat paradoxically, only blastic metastases are associated with increases in both markers (34). Increased osteoclast activity predicts a poor outcome, with increased relative risks (RRs) associated with high N-telopeptide (>100 nmol collagen equivalents/mM creatinine) for skeletal-related events (RR: 3.3, P
Aaron I. Vinik, MD, PhD, FCP, MACP, FACE ABSTRACT Objective: To review the current state of pancreatic neuroendocrine tumors (PNETS) Methods: The literature published between 2005 and 2014 in PUBMED, Medline, Google Scholar, Cochrane reports, and ClinicalTrials.gov was examined for relevance to the topic. Results: PNETS have an incidence 500 pmol/L is an independent indicator of poor outcome. This marker is also known to correlate with the number of liver metastases, so it would be appropriate to use it in the follow-up of NET patients. Furthermore, Stronge et al reported that an increase in pancreastatin levels following SST analog (SSA) therapy was associated with poor survival (31). Other studies have shown that pancreastatin should be measured prior to treatment and monitored during and after it. Plasma levels of this marker above 5,000 pg/mL pretreatment were associated with increased periprocedure mortality in patients with NETs who underwent hepatic artery chemoembolization (32). These observations suggest that pancreastatin is potentially a very useful marker for both diagnosis and monitoring treatment response. Neurokinin A (NKA) has been shown to have strong prognostic value. In 2006, Turner et al showed that patients with midgut carcinoid who had raised plasma NKA but reduced levels after SSA therapy had an 87% survival rate at 1 year compared with 40% in patients in whom the NKA level increased. They also concluded that any alteration in
NKA predicts improved or worsening survival (33). Bone alkaline phosphatase, an indicator of osteoblast function, and urinary N-terminal telopeptide (N-telopeptide), which reflects osteoclast activity or bone resorption, are useful for identifying bone metastases. Metastases from NETs can be either lytic and/or osteoblastic. Somewhat paradoxically, only blastic metastases are associated with increases in both markers (34). Increased osteoclast activity predicts a poor outcome, with increased relative risks (RRs) associated with high N-telopeptide (>100 nmol collagen equivalents/mM creatinine) for skeletal-related events (RR: 3.3, P
