Its metabolite, pancreastatin, may be of more utility in predicting survival since it is unaffected by proton pump inhibitor use and pernicious anemia, unlike CgA.47 Activin A, like CgA, was found to have high sensitivity but low specificity for CaHD.48 The role of other biomarkers with potentially better diagnostic utility such as the 51-gene, polymerase chain reaction-based NETest are still under investigation.49 This evidence concerns the gene CGA and pernicious anemia.