Prognostic value of initial pasting serum gastrin levels in patients with Zollinger-Ellison syndrome

Purpose: To assess the value of the initial fasting serum gastrin (FSG) at presentation in patients with Zollinger-Ellison Syndrome (ZES) in predictin g primary tumor characteristics and survival. Patients and Methods: A total of 239 patients were treated for ZES between December 1981 and September 1998, with a mean follow-up of 9.1 +/- 0.6 year s. At initial evaluation, 86 patients (36%) had mild (0 to 499 pg/mL), 61 ( 25.5%) had moderate (500 to 1,000 pg/mL), and 92 (38.5%) had severe (> 1,00 0 pg/mL) elevations in FSG. Primary tumor location and size, presence of ly mph node or hepatic metastases, and survival were analyzed based on the lev el of initial FSG, Results: In patients with sporadic ZES, but not in those with multiple endo crine neoplasia type 1 (MEN-1) and ZES, there was ct significant relationsh ip between the level of initial FSG and tumor size and location of primary tumor, frequency of lymph node and liver metastases, and survival, The medi an 5- and 10-year survival decreased with increasing initial FSG (P < .001) in patients with sporadic ZES; MEN-1 patients lived longer than sporadic Z ES patients (P = .012), and survival in this group was not associated with the level of initial FSG. Multivariate analysis showed that factors indepen dently associated with death from disease in patients with sporadic ZES wer e liver metastases (P = .0001), a pancreatic site (P = .0027), and primary tumor size (P = .011) but not initial FSG (P > .30). Conclusion: The severity of FSG at presentation is associated with size and site of tumor and the presence of hepatic metastases, factors that are sig nificant independent predictors of outcome. The level of FSG at presentatio n may be useful in planning the nature and extent of the initial evaluation and management in patients with sporadic ZES, J Clin Oncol 19:3051-3051. ( C) 2001 by American Society of Clinical Oncology.