Faculty Collaboration Database

Prognostic Utility of 24-Hour Urinary 5-HIAA Doubling Time in Patients With Neuroendocrine Tumors. Endocr Pract 2018 Aug;24(8):710-717

Date

08/08/2018

Pubmed ID

30084688

Pubmed Central ID

PMC8058621

DOI

10.4158/EP-2018-0022

Scopus ID

2-s2.0-85054893152 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

OBJECTIVE: New clinical prognostic tools are needed to select the population of patients with neuroendocrine tumors (NETs) that have a high risk of disease progression and disease-specific mortality (DSM). Biochemical biomarker doubling time (DT) is used clinically for prognosis prediction in several solid malignancies. The aim of the current study was to determine whether 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) level DT has any prognostic utility in patients with NETs.

METHODS: Patients with NETs were enrolled in a prospective study with comprehensive biochemical analysis. The current analysis included 90 subjects with increasing 5-HIAA levels in two consecutive measurements. DT was calculated using the Schwartz equation. The primary outcome measures were DSM and disease progression.

RESULTS: 5-HIAA DT of <434 days was associated with a higher rate of DSM ( P = .02), with positive and negative predictive values for DSM of 75 and 77%, respectively. The difference in DSM was accounted for mainly by patients with small intestine or unknown primary NET ( P = .01). In addition, a shorter 5-HIAA DT in patients with small intestine or unknown primary NET was associated with a higher risk of disease progression both in univariate ( P = .001) and multivariable analyses (hazard ratio, 15.8; 95% confidence interval, 1.3 to 198.0; P = .03).

CONCLUSION: 5-HIAA DT may be used as a risk stratification tool in patients with small intestine NET or NET of unknown primary after it is validated in an independent cohort and can assist in identifying patients with a high risk for disease progression and DSM.

ABBREVIATIONS: CT = computed tomography; DSM = disease-specific mortality; DT = doubling time; 5-HIAA = 5-hydroxyindoleacetic acid; MRI = magnetic resonance imaging; NET = neuroendocrine tumor; NETUP = neuroendocrine tumor of unknown primary; PET = positron emission tomography; PFS = progression-free survival; PNET = pancreatic neuroendocrine tumor; ROC = receiver operating characteristic; SINET = small-intestine neuroendocrine tumor.

Author List

Tirosh A, Nilubol N, Patel D, Kebebew E

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Disease Progression
Female
Humans
Hydroxyindoleacetic Acid
Intestinal Neoplasms
Intestine, Small
Male
Middle Aged
Neoplasms, Unknown Primary
Neuroendocrine Tumors
Pancreatic Neoplasms
Positron Emission Tomography Computed Tomography
Prognosis
Proportional Hazards Models
Prospective Studies
Time Factors