CHROMOGRANIN-A AND PANCREASTATIN-LIKE IMMUNOREACTIVITY IN HUMAN CARCINOID DISEASE

Objective: To evaluate chromogranin A (CgA) and pancreastatin-like imm unoreactivity (PST-L[) as tumor markers in human carcinoid disease, co mpared with urinary excretion of 5-hydroxyindole acetic acid (5-HIAA), and to evaluate their role as indicators of survival. Patients and me thods: Urinary 5-HIAA excretion was determined by a spectrophotometric method, while serum CgA and PST-LI were determined by radioimmunoassa y methods in 38 patients with midgut, 10 with foregut and one with hin dgut carcinoids. Results: in midgut carcinoid patients levels of 5-HIA A, CgA and PST-LI were raised by 76, 82 and 76%, respectively. The med ian CgA level in midgut carcinoid patients was significantly higher th an in the controls (193 compared with 12ng/ml; P<0.01). in the midgut carcinoid patients, the median CgA value was significantly higher in w omen who died (1990 ng/ml) than in those who survived (46 ng/ml; P<0.0 1), and significantly higher than in men, either survivors or non-surv ivors. The median PST-LI value was significantly higher in midgut carc inoid 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 i n 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 Cg A and PSI-LI levels in the foregut group were similar to the midgut gr oup. Conclusion: CgA and PST-LI are useful markers in the diagnosis of both midgut and foregut carcinoids. They are as good as, or more sens itive than, 5-HIAA.