Blood Molecular Genomic analysis predicts the disease course of GEP NET patients: a validation study of the predictive value of the NETest®.

Abstract:

:Reliable prediction of disease status is a major challenge in managing gastroenteropancreatic neuroendocrine tumors (GEP-NET). The aim of the study was to validate the NETest®, a blood molecular genomic analysis, for predicting the course of disease in individual patients compared to Chromogranin A (CgA). NETest® (normal ≤20%) and CgA (normal <100 µg/l) were measured in 152 GEP-NETs. Median follow-up was 36 [4-56] months. Progression free survival (PFS) was blindly assessed (RECIST 1.1). Optimal cutoffs (area-under-the-ROC curve (AUC)), odds ratios (OR), negative and positive predictive values (NPV/PPV) were calculated for predicting stable (SD) and progressive disease (PD). Of the 152 GEP-NETs, 86% were NETest®-positive and 52% CgA-positive. The NETest® AUC was 0.78 vs CgA 0.73 (p=NS). The optimal cut-offs for predicting SD and PD were 33% for the NETest® and 140 µg/l for CgA. Multivariate analyses identified NETest® as the strongest predictor for PD (OR: 5.7 [score: 34-79%]; 12.6 [score≥80%]) compared to CgA (OR 3.0), tumor grade (OR 3.1) or liver metastasis (OR 7.7). NETest® NPV for SD was 87% at 12 months. The PPV for PD were 47% and 64% (scores 34-79% and ≥80%, respectively). NETest® metrics were comparable in watchful waiting-, treatment- and no evidence of disease (NED) subgroups. For CgA (>140ng/ml), NPV and PPV were 83% and 52%. CgA could not predict PD in watchful waiting or NED subgroups. The NETest® reliably predicted SD and was the strongest predictor of PD. CgA had lower utility. The NETest® anticipates RECIST defined disease status up to one year before imaging alterations are apparent.

journal_name

Neuroendocrinology

journal_title

Neuroendocrinology

authors

van Treijen MJC,van der Zee D,Heeres BC,Staal FCR,Vriens MR,Saveur LJ,Verbeek WHM,Korse CM,Maas M,Valk GD,Tesselaar M

doi

10.1159/000509091

subject

Has Abstract

pub_date

2020-06-03 00:00:00

eissn

0028-3835

issn

1423-0194

pii

000509091

pub_type

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