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@article{Modlin:2021:10.1097/SLA.0000000000005026,
author = {Modlin, IM and Kidd, M and Frilling, A and Falconi, M and Filosso, PL and Malczewska, A and Kitz, A},
doi = {10.1097/SLA.0000000000005026},
journal = {Annals of Surgery},
pages = {481--490},
title = {Molecular genomic assessment using a blood-based mRNA signature (NETest) is cost effective and predicts neuroendocrine tumor recurrence with 94% accuracy.},
url = {http://dx.doi.org/10.1097/SLA.0000000000005026},
volume = {274},
year = {2021}
}

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TY  - JOUR
AB  - INTRODUCTION: Identification of residual disease after neuroendocrine tumor (NET) resection is critical for management. Post-surgery imaging is insensitive, expensive and current biomarkers ineffective. We evaluated whether the NETest, a multigene liquid biopsy blood biomarker, correlated with surgical resection and could predict recurrence. METHODS: Multicenter evaluation of NET resections over 24months (n=103): 47 pancreas, 26 small bowel, 26 lung, 2 appendix, 1 duodenum, 1 stomach. Surgery: R0 (83), R1/R2 (20). 1ml blood collected at D0 and POD30. Transcript quantification by PCR (normal: ≤20), CgA by NeoLISA (normal≤108ng/mL). Standard-of-care (SoC) follow-up costs were calculated and compared to POD30 NETest-stratification approach. Analyses: Wilcoxon-paired test, Chi2-test. RESULTS: D0 biomarkers: NETest: 103/103 (100%)-positive while 23/103 (22%) were CgA-positive (Chi2=78, p<0.0001).In the R0 group, the NETest decreased 59±28 to 26±23 (p<0.0001); 36% (30/83) remained elevated. No significant decrease was evident for CgA. In the R1/R2 group the NETest decreased but 100% remained elevated. CgA levels did not decrease.An elevated POD30 NETest were present in R0 and 25 (83%) developed radiological recurrences. Normal score R0s (n=53) did not develop recurrence (Chi2=56, p<0.0001). Recurrence prediction was 94% accurate with the NETest.Cost evaluation: Using the NETest to stratify postoperative imaging resulted in a cost-savings of 42%. CONCLUSION: NETest diagnosis is more accurate than CgA (100% vs. 22%). Surgery significantly decreased NETest. An elevated POD30 NETest predicted recurrence with 94% accuracy and post-surgical POD30 NETest follow-up stratification decreased costs by 42%. CgA had no surgical utility. Further studies would define the accuracy and cost-effectiveness of the NETest in the detection of post-operative recurrent disease.
AU  - Modlin,IM
AU  - Kidd,M
AU  - Frilling,A
AU  - Falconi,M
AU  - Filosso,PL
AU  - Malczewska,A
AU  - Kitz,A
DO  - 10.1097/SLA.0000000000005026
EP  - 490
PY  - 2021///
SN  - 0003-4932
SP  - 481
TI  - Molecular genomic assessment using a blood-based mRNA signature (NETest) is cost effective and predicts neuroendocrine tumor recurrence with 94% accuracy.
T2  - Annals of Surgery
UR  - http://dx.doi.org/10.1097/SLA.0000000000005026
UR  - https://www.ncbi.nlm.nih.gov/pubmed/34183517
UR  - https://journals.lww.com/annalsofsurgery/Abstract/9000/Molecular_Genomic_Assessment_using_a_blood_based.93465.aspx
UR  - http://hdl.handle.net/10044/1/90439
VL  - 274
ER  -

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