Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2020; 26(19): 2305-2322
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2305
Pancreatic neuroendocrine tumors: A review of serum biomarkers, staging, and management
Zu-Yi Ma, Yuan-Feng Gong, Hong-Kai Zhuang, Zi-Xuan Zhou, Shan-Zhou Huang, Yi-Ping Zou, Bo-Wen Huang, Zhong-Hai Sun, Chuan-Zhao Zhang, Yun-Qiang Tang, Bao-Hua Hou
Zu-Yi Ma, Yuan-Feng Gong, Hong-Kai Zhuang, Zi-Xuan Zhou, Shan-Zhou Huang, Yi-Ping Zou, Bo-Wen Huang, Zhong-Hai Sun, Chuan-Zhao Zhang, Bao-Hua Hou, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Zu-Yi Ma, Hong-Kai Zhuang, Yi-Ping Zou, Zhong-Hai Sun, Shantou University of Medical College, Shantou 515000, Guangdong Province, China
Yun-Qiang Tang, Department of Hepatobiliary Surgery, the Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510080, Guangdong Province, China
Author contributions: All authors contributed to the preparation of manuscript, literature search, and review of the manuscript.
Supported by Guangzhou Health and Family Planning Technology Project, No. 20191A011096; the National Natural Science Foundation of China, No. 81602172; Guangdong Provincial Science and Technology Plan Projects, No. 2016A030313769; and Guangzhou Science and Technology Plan of Scientific Research Projects, No. 201707010323.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bao-Hua Hou, MD, PhD, Director, Professor, Surgeon, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, Guangdong Province, China. houbaohuahbp@163.com
Received: January 1, 2020
Peer-review started: January 1, 2020
First decision: January 16, 2020
Revised: March 27, 2020
Accepted: April 28, 2020
Article in press: April 28, 2020
Published online: May 21, 2020
Processing time: 141 Days and 7.2 Hours
Abstract

Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of tumors with complicated treatment options that depend on pathological grading, clinical staging, and presence of symptoms related to hormonal secretion. With regard to diagnosis, remarkable advances have been made: Chromogranin A is recommended as a general marker for pNETs. But other new biomarker modalities, like circulating tumor cells, multiple transcript analysis, microRNA profile, and cytokines, should be clarified in future investigations before clinical application. Therefore, the currently available serum biomarkers are insufficient for diagnosis, but reasonably acceptable in evaluating the prognosis of and response to treatments during follow-up of pNETs. Surgical resection is still the only curative therapeutic option for localized pNETs. However, a debulking operation has also been proven to be effective for controlling the disease. As for drug therapy, steroids and somatostatin analogues are the first-line therapy for those with positive expression of somatostatin receptor, while everolimus and sunitinib represent important progress for the treatment of patients with advanced pNETs. Great progress has been achieved in the combination of systematic therapy with local control treatments. The optimal timing of local control intervention, planning of sequential therapies, and implementation of multidisciplinary care remain pending.

Keywords: Pancreatic neuroendocrine tumor; Serum biomarkers; Staging; Grading; Management; Therapy

Core tip: Pancreatic neuroendocrine tumors are a heterogeneous group of tumors with complicated treatment. There are several highlights of our manuscript. First, we summarize conventional and new advances in serum biomarkers, like circulating tumor cells, multiple transcript analysis, microRNA profile, and cytokines. Then we review the changes of each guidelines of grading and staging systems and the clinical evidence behind them. Lastly, surgical resection is still the only curative therapeutic option for localized pancreatic neuroendocrine tumors. Great progress has been achieved in drug therapy and the combination with local control treatments. We summarize new advances in detail and provide potential strategies for the management of neuroendocrine tumor associated with liver metastases.