The Clinical Utility of the NETest in Patients with Small Intestinal Neuroendocrine Neoplasms (Si-NENs): A “Real-Life” Study

Author:

Gertner Julian1ORCID,Tsoli Marina2ORCID,Hayes Aimee R.2,O’Mahony Luke Furtado3,Laskaratos Faidon-Marios4,Glover Thomas4,Karia Priyesh5,Butt Mohsin F.6ORCID,Eastwood Oliver2,Mandair Dalvinder2,Caplin Martyn2,Toumpanakis Christos2

Affiliation:

1. University College London Hospital, London NW1 2BU, UK

2. Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London NW3 2QG, UK

3. Department of Oncology, University of Oxford, Oxford OX1 2JD, UK

4. St Mark’s Hospital, London HA1 3UJ, UK

5. St. Peter’s Hospital, Ashford TW15 3AA, UK

6. NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK

Abstract

Current biomarkers do not adequately predict the behaviour of neuroendocrine neoplasms (NENs). This study assessed the NETest, a multianalyte blood biomarker, in patients with small intestinal NENs (Si-NENs). We studied two patient groups: Group 1: metastatic Si-NENs (n = 102) and Group 2: post-operatively disease-free according to 68Ga-DOTATATE PET (n = 16). NETest scores were ≤20% (normal), 21–40% (low), 41–79% (intermediate), or ≥80% (high). Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan–Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model. In Group 1, the median NETest score was 40% (IQR: 33.3–46.7%). The NETest value (HR: 1.032, 95% CI: 1.003–1.062, p = 0.033) and high-risk NETest category (HR: 10.5, 95% CI: 1.35–81.7, p = 0.025) were independent predictors of PFS, along with presence of lung metastases, CgA levels > 10 × ULN, and tumour growth rate (TGR). Independent predictors of OS were the NETest value (HR: 1.035, 95% CI: 1.005–1.066, p = 0.024) and high-risk NETest category (HR: 15.2, 95% CI: 1.52–151, p = 0.02), along with presence of lung metastases and CgA levels > 10 × ULN. In Group 2, ROC analysis identified an AUC of 0.909 (95% CI: 0.75–0.100) for prediction of local or metastatic recurrence. Blood NETest scores were associated with PFS and OS in patients with metastatic Si-NENs, along with TGR, CgA > 10 × ULN, and presence of lung metastases.

Funder

WREN laboratories

Publisher

MDPI AG

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