Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2019; 11(2): 139-152
Published online Feb 15, 2019. doi: 10.4251/wjgo.v11.i2.139
C-reactive protein may be a prognostic factor for the whole gastroenteropancreatic neuroendocrine tumor group
Ömer Komaç, Göksel Bengi, Özgül Sağol, Mesut Akarsu
Ömer Komaç, Department of Internal Medicine, Dokuz Eylul University Faculty of Medicine, Izmir 35000, Turkey
Göksel Bengi, Mesut Akarsu, Department of Gastroenterology, Dokuz Eylul University Faculty of Medicine, Izmir 35000, Turkey
Özgül Sağol, Department of Pathology, Dokuz Eylul University Faculty of Medicine, Izmir 35000, Turkey
Author contributions: Bengi G, Komaç Ö, Akarsu M and, Sağol Ö contributed equally to this work, designed the research, drafted the manuscript and provided the administrative and technical support.
Institutional review board statement: This study was approved by the Ethics Committee of Dokuz Eylul University in June 2017.
Informed consent statement: Informed consent was provided by all the participants.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Göksel Bengi, MD, Assistant Professor, Department of Gastroenterology, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir 35000, Turkey. drgokselbengi@hotmail.com
Telephone: +90-532-4626972 Fax: +90-232-4123799
Received: April 20, 2018
Peer-review started: April 21, 2018
First decision: May 29, 2018
Revised: August 24, 2018
Accepted: October 23, 2018
Article in press: October 23, 2018
Published online: February 15, 2019
Abstract
BACKGROUND

Long non-coding RNAs (lncRNAs) are a kind of single-stranded RNA of more than 200 nucleotides in length and have no protein-coding function. Amounting studies have indicated that lncRNAs could play a vital role in the initiation and development of cancers, including gastric cancer (GC). Considering the crucial functions of lncRNAs, the identification and exploration of novel lncRNAs in GC is necessary.

AIM

To identify independent prognostic markers for the whole gastroenteropancreatic neuroendocrine tumor (GEP-NET) group.

METHODS

Ninety-three patients diagnosed with GEP-NETs within a specified period were included in this study. Patient data were retrospectively analyzed. The relationships between all independent variables and 5-year survival status calculated during the follow-up period (months) were assessed. In addition, the relationships between the independent variables were investigated.

RESULTS

When 5-year survival rate was compared, a statistically significant relationship between the age at diagnosis, male gender, tumor size, tumor stage, liver and/or distant metastasis, and tumor grade determined by the Ki-67 level and mitotic count, and the level of C-reactive protein (CRP), was observed. The mean survival (overall survival) of the study group was 102.5 ± 6.3 (SD) mo. The percentages of 1, 3 and 5-year survival were 90%, 72%, and 61%, respectively. In 63 of 93 patients, Ki-67 and the mitotic count determined the same grade. The Ki-67 levels in 29 patients and the mitotic count in only 1 patient were in the higher grade. The risk of death increased by 4% for every 1 year increase at the diagnosis age and was 2.0-fold higher for male patients, 3.0-fold higher for G3 according to the mitotic count, 3.7-fold higher for G3 according to the Ki-67 level, 12.7-fold higher for cases with tumor stage 3 or 4 by a 1 cm increase in the ratio of 9% in tumor size, and 6.1-fold higher for patients with liver metastasis for every 1 mg/dL increase in the ratio of 1.5% in CRP level. There was a significant difference between pancreatic and stomach NETs in favor of stomach tumors in terms of survival.

CONCLUSION

Tumor site, stage, grade and Ki-67 level affected patient survival, and it was observed that CRP affected disease progression (particularly if it was > 20 mg/dL). However, a relationship between surgical resection of the lesion and survival was not shown. Larger scale prospective studies are required to determine whether CRP level may be a poor prognostic factor for the entire GEP-NET group.

Keywords: Gastroenteropancreatic neuroendocrine tumors, C-reactive protein, Prognostic factor, Neuroendocrine tumors, Gastrointestinal system

Core tip: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) constitute a heterogeneous group of tumors with variable clinical presentations, different growth rates, and unpredictable prognoses. In our study, we aimed to identify the independent prognostic markers for the whole GEP-NET group. It was observed that the biochemical parameter, C-reactive protein (CRP), affected disease progression (particularly if it was > 20 mg/dL). However, larger scale prospective studies are required to determine whether CRP level may be a poor prognostic factor for the entire GEP-NET group.