To evaluate chromogranin A (CgA) and pancreastatin-like immunoreactivity (PST-LI) as tumor markers in human carcinoid disease, compared with urinary excretion of 5-hydroxyindole acetic acid (5-HIAA), and to evaluate their role as indicators of survival.Patients and methods:
Urinary 5-HIAA excretion was determined by a spectrophotometric method, while serum CgA and PST-LI were determined by radioimmunoassay methods in 38 patients with midgut, 10 with foregut and one with hindgut carcinoids.Results:
In midgut carcinoid patients levels of 5-HIAA, CgA and PST-LI were raised by 76, 82 and 76%, respectively. The median CgA level in midgut carcinoid patients was significantly higher than in the controls (193 compared with 12ng/ml; P<0.01). In the midgut carcinoid patients, the median CgA value was significantly higher in women who died (1990 ng/ml) than in those who survived (46ng/ml; P<0.01), and significantly higher than in men, either survivors or non-survivors. The median PST-LI value was significantly higher in midgut carcinoid patients than in the control group (2282 compared with 33 pg/ml; P< 0.01). In women, the median PST-LI level was significantly higher in non-survivors than in survivors (9088 compared with 1337 pg/ml; P<0.01), and significantly higher than in male survivors and non-survivors. In foregut carcinoid patients, levels of CgA, PST-LI and 5-HIAA were increased in nine, eight and one patient, respectively. The median CgA and PST-LI levels in the foregut group were similar to the midgut group.Conclusion:
CgA and PST-LI are useful markers in the diagnosis of both midgut and foregut carcinoids. They are as good as, or more sensitive than, 5-HIAA.