Plasma Chromogranin A as Marker for Survival in Patients With Metastatic Endocrine Gastroenteropancreatic Tumors

Background & Aims: The prognostic role of plasma chromogranin A in patients with neuroendocrine tumors is unclear. We investigated the role of chromogranin A in predicting survival and hypothesized that chromogranin A mirrors tumor burden and that a rapid increase after a phase of stable plasma chromogranin A levels might predict exploding tumor growth. Methods: Three hundred forty-four patients with metastatic, well-differentiated neuroendocrine tumors were included. A subsample of 102 patients was investigated to correlate radiologically classified tumor burden with plasma chromogranin A. Hepatic tumor burden (0%, 0%–25%, 25%–50%, >50%) was assessed from computed tomography/magnetic resonance imaging scans. Follow-up information until death was generated in regular intervals. Results: Plasma chromogranin A levels (U/L) vary between tumor entities (Kruskal–Wallis, P 10 CgA level scale; 95% confidence interval [CI], 1.75–2.62; P P = .57; 95% CI, 0.44–0.70; P Conclusions: Increased plasma chromogranin A in patients with metastatic neuroendocrine tumors is predictive for shorter survival. There was a modest correlation between chromogranin A levels and hepatic tumor burden. We hypothesized further that a sudden increase in individual chromogranin A levels indicates unfavorable outcome.