Elevated Plasma Pancreastatin, but Not Chromogranin A, Predicts Survival in Neuroendocrine Tumors of the Duodenum

J Am Coll Surg. 2016 Apr;222(4):534-42. doi: 10.1016/j.jamcollsurg.2015.12.014. Epub 2015 Dec 21.


Background: Neuroendocrine tumors (NETs) of the duodenum are rare, heterogeneous, and often indolent neoplasms. We hypothesized that elevated pancreastatin levels are an indicator of a poor prognosis in well-differentiated duodenal NETs.

Study design: Data from patients diagnosed with a primary duodenal NET were analyzed. Patients that underwent esophogogastroduodenoscopy, endoscopic ultrasound, or exploratory surgery to localize their neoplasm and whose tumors were confirmed histologically were included.

Results: Eighty-four patients were diagnosed with duodenal NETs from January 1991 to January 2014. Seventy-five percent and 21% of patients had their tumor localized by esophogogastroduodenoscopy and endoscopic ultrasound, respectively. The remaining 4% were localized during exploratory surgery. The 5-year Kaplan-Meier survival rate for the entire cohort (N = 84) was 80%. Survival sorted by normal vs abnormal pancreastatin level was statistically significant (p < 0.0001). Five-year survival rates were 94% and 37% for normal and abnormal pancreastatin, respectively. In contrast, survival sorted by normal vs abnormal plasma chromogranin A level was not statistically significant (p = 0.24).

Conclusions: Patients with primary duodenal NETs have high 5-year survival rates. Serial monitoring of plasma pancreastatin levels can identify patients who have a poor prognosis.

MeSH terms

  • Aged
  • Chromogranin A / metabolism*
  • Duodenal Neoplasms / metabolism*
  • Duodenal Neoplasms / mortality*
  • Duodenal Neoplasms / surgery
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / metabolism*
  • Neuroendocrine Tumors / mortality*
  • Neuroendocrine Tumors / surgery
  • Pancreatic Hormones / metabolism*
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Survival Rate


  • CHGA protein, human
  • Chromogranin A
  • Pancreatic Hormones
  • pancreastatin