• Cansu G Genç, JilesenAnneke P JAPJDepartment of Surgery, Academic Medical Center, Amsterdam, The Netherlands., Nieveen van DijkumEls J MEJMDepartment of Surgery, Academic Medical Center, Amsterdam, The Netherlands., Heinz-Josef Klümpen, van EijckCasper H JCHJDepartment of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Ignat Drozdov, Anna Malczewska, Mark Kidd, and Irvin Modlin.
• Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
• J Surg Oncol. 2018 Jul 1; 118 (1): 37-48.

BackgroundRecurrence of pancreatic neuroendocrine tumors (pNET) after surgery is common. Strategies to detect recurrence have limitations. We investigated the role of clinical criteria and the multigene polymerase chain reaction-based NETest during post-operative follow-up of pNET.MethodsWe studied 3 groups of resections: R0 with no recurrence (n = 11), R0 with recurrence (n = 12), and R1 with no recurrence (n = 12). NETest levels (>40%) were compared with chromogranin A (CgA) and clinicopathological criteria (CC; grade, lymph node metastases, size). Nonparametric, receiver operating characteristics, logistic regression, and predictive feature importance analyses were performed.ResultsNETest was higher in R0 with recurrence (56 ± 8%) compared with R1 with no recurrence (39 ± 6%) and R0 with no recurrence (28 ± 6%, P < .005). NETest positively correlated with recurrence (area under the curve: 0.82), CgA was not (area under the curve: 0.51 ± 0.09). Multiple regression analysis defined factor impact as highest for NETest (P < .005) versus CC (P < .03) and CgA (P = .23). NETest gave false positive or negative recurrence in 18% using a 40% cutoff. Logistic regression modeling of CC was 83% accurate; it was 91% when the NETest was included. Combining CC and NETest was approximately 2× more effective than individual CC alone (increase in R 2 value from 43% to 80%).ConclusionsA multigene blood test facilitates effective identification of pNET recurrence, prediction of disease relapse, and outperforms CgA.© 2018 Wiley Periodicals, Inc.

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