α-Fetoprotein and human chorionic gonadotrophin-β as prognostic markers in neuroendocrine tumour patients

Abstract

Serum chromogranin A is the most useful general and prognostic tumour marker available for neuroendocrine tumour (NET) patients. The role of other tumour markers is less clear. In order to determine the diagnostic and prognostic value of serum afetoprotein (AFP) and human chorionic gonadotrophin-b (hCGb) in NETs, a database containing biochemical, histological, and survival data on 360 NET patients was constructed. This data was statistically assessed, using Statistical Package for the Social Sciences, to determine the utility of commonly measured tumour markers with particular emphasis on AFP and hCGb. a-Fetoprotein and hCGb were raised in 9.5 and 12.3% of patients respectively and jointly raised in 9.1% of patients in whom it was measured. aFetoprotein levels associated strongly and positively with tumour grade, serum CgA and hCGb levels, and worse survival. Human chorionic gonadotrophin-b levels also associated strongly and positively with serum CgA and AFP levels, and worsening survival. aFetoprotein and hCGb are elevated in high-grade NETs, with a rapidly progressive course and poorer survival. They also correlate with chromogranin-A, which is known to be a marker of tumour burden and to have prognostic value. Thus AFP and hCGb are clinically important in NETs and when elevated are poor prognostic markers.

Molar pregnancy after tubal ligation in a patient with neuroendocrine tumour: when a rare condition coincides with an unexpected diagnosis

“…The result of the urinary β hCG was indeterminate, so a serum quantitative β hCG was ordered and found to be excessively high at over 400 000 U/L. β hCG secreting NETs have been reported but are rare, with mean β hCG levels of 198.7 U/L, so significantly lower than in our patient 6 7. Peak normal pregnancy levels of β hCG are typically below 100 000 U/L, whereas 40% of complete molar pregnancies are associated with hCG levels >100 000 U/L 8.…”

Metastatic neuroendocrine carcinoma presenting as multifocal liver lesions with elevated alpha‐fetoprotein

“…We present a rare case of a NET with metastatic disease to the liver presenting with an AFP of 8705 ng/mL. While elevation in AFP to this extent has been noted in other malignancies with metastatic disease to the liver, this has infrequently been reported in NET with tumor burden in the liver …”

“…6,7 One study evaluated using AFP as a tumor marker in NET to determine survival; however, the number of patients with elevated AFP was limited and the average AFP level was less than 300 ng/mL. 8 We present a case of NET with liver involvement with an AFP elevated >8000 ng/mL. To our knowledge, this is one of the first case reports of a NET causing a marked elevation of AFP.…”

“…There are rare clinical case reports describing NET producing elevation in AFP, some of which lack liver metastasis . One study evaluated using AFP as a tumor marker in NET to determine survival; however, the number of patients with elevated AFP was limited and the average AFP level was less than 300 ng/mL . We present a case of NET with liver involvement with an AFP elevated >8000 ng/mL.…”

Circulating biomarkers in gastroenteropancreatic neuroendocrine tumours

“…Assays for the intact glycoprotein and its a and b subunits have been used as markers to screen for a number of different tumours including NETs (Grossmann et al 1994, Shah et al 2008. In particular, HCGa and b subunits have been found to be increased in patients with malignant pancreatic NETs (pNETs).…”