Chromogranin A as a valid marker in oncology: Clinical application or false hopes?

Table 1 Non cancerous causes of chromogranin A elevation

Disease
Cardiovascular	Endocrine	Gastrointestinal	Inflammatory
Acute coronary syndrome	Hyperparathyroidism	Chronic atrophic gastritis	Chronic bronchitis
Arterial hypertension	Hyperthyroidism	Chronic hepatitis	Chronic obstructive pulmonary disease
Cardiac insufficiency	Hypercortisolism	Inflammatory/irritable bowel syndrome	Giant cell arthritis
		Liver cirrhosis	Rheumatoid arthritis
		Pancreatitis	Systemic inflammatory response syndrome
Drugs
Corticoids	H2 receptor antagonist	Proton pump inhibitor
Status
Exercise	Ingestion of a meal	Pregnancy
Factors having potential influence on sample
Fibrin presence	Haemolysis	Imposing effect: Autoantibodies presence (RF-IgM, Avidine, Heterofile)	Late afternoon/night > morning
Lipaemia	Plasma > serum	-

Table 2 Frequent cancer-related causes of increased chromogranin A

Cancer	Neuroendocrine tumors
Breast	Colorectal
Colon	Gastric
Hepatocellular	Medullary thyroid
Ovarian	Neuroblastoma
Pancreatic	Pancreatic
Prostate	Paraganglioma
	Pheochromocytoma
	Pituitary
	Small cell lung
	Small intestinal

Table 3 Chromogranin A diagnostic accuracy in neuroendocrine tumor studies

Type (no pts)	CgA cut-off	Sensitivity (%)	Specificity (%)	Ref.
NET (128)	100 μg/L	59	68	[57]
NET (127)	34.7 u/L	67.9	85.7	[35]
NET (80)	17 u/L	56.3	100	[58]
NET (63)	34 u/L	55	94	[59]
GEP/NET (61)	20 u/L	92	83	[50]
	100 u/L	47	99
GEP/NET (124)	130 μg/L	62.9	98.4	[16]
GEP/NET (202)	53 ng/mL	71.3	77.8	[60]
NET (120)	98 ng/mL	79	NA	[61]
GEP/NET (119)	2.8 nmol/L	92.9	100	[62]

no: Number; pts: Patients; NA: Non available; CgA: Chromogranin A; NET: Neuroendocrine tumor; GEP: Gastroenteropancreatic.