This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berger, A. C. Articles by Alexander, H. R. Search for Related Content PubMed PubMed Citation Articles by Berger, A. C. Articles by Alexander, H. R. Social Bookmarking                            What's this?

Prognostic Value of Initial Fasting Serum Gastrin Levels in Patients With Zollinger-Ellison Syndrome

From the Surgery Branch and Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute; Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases; and Department of Diagnostic Radiology, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD.

Address reprint requests to H. Richard Alexander, MD, FACS, Surgery Branch, Center for Cancer Research, National Cancer Institute, Bldg 10, Rm 2B07, National Institutes of Health, Bethesda, MD 20892; email: richard_alexander{at}nih.gov

PURPOSE: To assess the value of the initial fasting serum gastrin (FSG) at presentation in patients with Zollinger-Ellison Syndrome (ZES) in predicting 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 years. 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 (> 1,000 pg/mL) elevations in FSG. Primary tumor location and size, presence of lymph node or hepatic metastases, and survival were analyzed based on the level of initial FSG.

RESULTS: In patients with sporadic ZES, but not in those with multiple endocrine neoplasia type 1 (MEN-1) and 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. The median 5- and 10-year survival decreased with increasing initial FSG (P < .001) in patients with sporadic ZES; MEN-1 patients lived longer than sporadic ZES patients (P = .012), and survival in this group was not associated with the level of initial FSG. Multivariate analysis showed that factors independently associated with death from disease in patients with sporadic ZES were 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 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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. Furukawa, M. Raffeld, C. Mateo, A. Sakamoto, T. W. Moody, T. Ito, D. J. Venzon, J. Serrano, and R. T. Jensen Increased Expression of Insulin-Like Growth Factor I and/or Its Receptor in Gastrinomas Is Associated with Low Curability, Increased Growth, and Development of Metastases Clin. Cancer Res., May 1, 2005; 11(9): 3233 - 3242. [Abstract] [Full Text] [PDF]

				M. Dong, Z. Li, M. Zang, D. I. Pinon, T. P. Lybrand, and L. J. Miller Spatial Approximation between Two Residues in the Mid-region of Secretin and the Amino Terminus of Its Receptor: INCORPORATION OF SEVEN SETS OF SUCH CONSTRAINTS INTO A THREE-DIMENSIONAL MODEL OF THE AGONIST-BOUND SECRETIN RECEPTOR J. Biol. Chem., November 28, 2003; 278(48): 48300 - 48312. [Abstract] [Full Text] [PDF]