A team from Bethesda, Maryland, USA, assessed the prognostic value of initial fasting serum gastrin (FSG) levels in patients with Zollinger-Ellison Syndrome (ZES). They investigated whether they could be used to predict primary tumor characteristics and survival.
A total of 239 patients were treated for ZES between 1981 and 1998, with a mean follow-up of 9 years.
At initial evaluation, 36% of patients had mild (0 to 499 pg/mL), 26% had moderate (500 to 1,000 pg/mL), and 39% had severe (>1,000 pg/mL) elevations in FSG.
|In sporadic ZES patients, initial fasting gastrin related to:|
- tumor size
- primary tumor location
- frequency of lymph node/liver metastasis
|Journal of Clinical Oncology|
Primary tumor location and size, presence of lymph node or hepatic metastases, and survival were analyzed, based on the level of initial FSG.
In patients with sporadic ZES, there was a significant relationship between the level of initial FSG and tumor size and location of primary tumor, frequency of lymph node and liver metastases, and survival. This was not the case in those with multiple endocrine neoplasia type 1 (MEN-1) and ZES
The researchers found that the median 5- and 10-year survival decreased with increasing initial FSG, in patients with sporadic ZES. MEN-1 patients lived longer than sporadic ZES patients, and survival in this group was not associated with the level of initial FSG.
Multivariate analysis was used to determine the factors independently associated with death from disease, in patients with sporadic ZES. These were liver metastases, a pancreatic site, and primary tumor size, but not initial FSG.
Adam C. Berger, of the National Institutes of Health, Bethesda, said on behalf of the group, "The severity of fasting serum gastrin at presentation is associated with size and site of tumor, and the presence of hepatic metastases. These factors are significant independent predictors of outcome."
"The level of FSG at presentation may be useful in planning the nature and extent of the initial evaluation and management, in patients with sporadic ZES," he concluded.