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Chromogranin A in the Follow-up of Gastroenteropancreatic Neuroendocrine Neoplasms

Is It Really Game Over? A Systematic Review and Meta-analysis

Rossi, Roberta Elisa, MD; Ciafardini, Clorinda, BS; Sciola, Valentina, MD; Conte, Dario, MD; Massironi, Sara, MD, PhD

doi: 10.1097/MPA.0000000000001184

Objectives Little is known about chromogranin A (CgA) during follow-up of gastroenteropancreatic neuroendocrine neoplasms. We hypothesized that serial CgA monitoring might be useful for the assessment of tumor progression, and we performed a systematic review of the literature and meta-analysis.

Methods A bibliographical search was performed in PubMed using “chromogranin A” and “neuroendocrine tumors” and “follow-up” and “biomarker” to identify all pertinent articles published in the last 10 years.

Results Eight studies were included in current meta-analysis. Chromogranin A as a follow-up marker shows sensitivity between 46% and 100% and specificity between 68% and 90%. The meta-analysis results showed an overall accuracy of 84% (95% confidence interval [CI], 81–86.6), a cumulative sensitivity of 74.6% (95% CI, 61.9–85.4), and a cumulative specificity of 84.7% (95% CI, 81.3–87.7). These data indicate that circulating CgA has a better overall accuracy in the follow-up setting; it can be used to rule the diagnosis of recurrence/progression in, rather than to rule it out.

Conclusions Chromogranin A is more reliable when used to monitor disease progression and response to treatment and for the early detection of recurrence after treatment rather than in the diagnostic setting. It is more sensible to use this marker in those cases where the initial values were impaired.

From the Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Department of Pathofisiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

Received for publication March 20, 2018; accepted September 4, 2018.

Address correspondence to: Roberta Elisa Rossi, MD, Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via F. Sforza 35, 20122 Milan, Italy (e-mail:

The authors declare no conflict of interest.

This study did not receive financial support.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.