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Article Open Access

Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms

  • Authors:
    • Na Li
    • Jianduo An
    • Yanping Hu
  • View Affiliations / Copyright

    Affiliations: Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, P.R. China
    Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 6
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    Published online on: October 24, 2025
       https://doi.org/10.3892/etm.2025.13001
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Abstract

The diagnosis of high‑grade gastroenteropancreatic neuroendocrine neoplasms (HG‑GEP NENs) primarily relies on histopathological differentiation and mitotic count assessment. Due to interobserver variability in morphological evaluation, reliable molecular diagnostic biomarkers are needed to support accurate classification, particularly in challenging cases where the distinction between well‑differentiated neuroendocrine tumours grade 3 (NET G3) and poorly differentiated neuroendocrine carcinoma (NEC) is ambiguous. The present study aimed to identify clinicopathological markers that facilitate the differential diagnosis of HG‑GEP NENs. A total of 34 patients with HG‑GEP NENs were included in study. Integrated bioinformatics analysis, including protein‑protein interaction network construction from the GSE211485 dataset and subsequent validation using The Cancer Genome Atlas data, identified checkpoint kinase 1 (CHEK1) as a potential molecular marker for diagnosing HG‑GEP NENs, which also showed prognostic significance in digestive system tumours. Despite no significant difference in overall CHEK1 DNA levels between groups, high CHEK1 expression was significantly more prevalent in the NEC group than in the NET G3 group (P=0.0113), with the small cell NEC (SCNEC) subgroup exhibiting the highest frequency (P=0.0075). Receiver operating characteristic curve analysis results revealed that high CHEK1 expression distinguished NEC from NET G3 [area under the curve (AUC)=0.8029]. When further stratified, its diagnostic performance was more pronounced for SCNEC (AUC=0.8708) than for large cell NEC (AUC=0.7102). These findings suggest that CHEK1 may serve as a potential molecular biomarker for the differential diagnosis of HG‑GEP NENs. Although further large‑scale clinicopathological studies are needed, CHEK1 expression demonstrates diagnostic potential and could be utilised to inform standard treatment plans.
View Figures

Figure 1

Workflow diagram and case selection
flowchart. (A) Workflow of the study. (B) Case inclusion and
screening flowchart. DEGs, differentially expressed genes; KEGG,
Kyoto Encyclopaedia of Genes and Genomes; GO, Gene Ontology; PPI,
protein-protein interaction; RT-qPCR, reverse
transcription-quantitative PCR; HG-GEP NENs, high-grade
gastroenteropancreatic neuroendocrine neoplasms; FFPE,
formalin-fixed paraffin-embedded; NET G3, neuroendocrine tumour
grade 3; NEC, neuroendocrine carcinoma; SCNEC, small cell NEC;
LCNEC, large-cell NEC; WHO, World Health Organisation;
CHEK1, checkpoint kinase 1.

Figure 2

Overall analysis of the DEGs. (A)
Volcano plot of the DEGs. Red and blue dots represent significantly
upregulated and downregulated genes, respectively (adjusted P-value
<0.05 and |log2FC|>1). (B) GO and KEGG enrichment
analysis of the DEGs. Bar plots show the top significantly enriched
terms. The x-axis represents the enrichment significance
[-Log10(adjusted P-value)], and numbers in parentheses
indicate gene counts for each term. DEGs, differentially expressed
genes; BP, biological processes; CC, cellular component; MF,
molecular function; KEGG, Kyoto Encyclopedia of Genes and
Genomes.

Figure 3

PPI network analysis of DEGs. (A) PPI
network constructed from DEGs. (B) Five hub genes (CHEK1,
CENPF, UBE2T, E2F7 and ITGB3BP) were
identified within the network. DEGs, differentially expressed
genes; PPI, protein-protein interaction.

Figure 4

Prognostic and diagnostic analysis of
the DEGs identified from the GSE211485 dataset. (A-E) Kaplan-Meier
survival curves showing the association between the expression
levels of the five identified DEGs (A) CHEK1, (B)
CENPF, (C) E2F7, (D) ITGB3BP and (E)
UBE2T, and overall survival in patients with digestive
system tumours. The HR and 95% CIs were calculated using the
log-rank test. (F) ROC curve showing the diagnostic performance of
CHEK1 expression for distinguishing tumour from normal
tissues. The AUC indicates diagnostic accuracy. (G) Expression of
CHEK1 [log2 (TPM +1)] in digestive system tumour tissues
compared with adjacent normal tissues. Statistical significance is
indicated as ***P<0.001. DEGs, differentially
expressed genes; CI, confidence interval; AUC, area under the
curve; HR, hazard ratio; CHEK1, checkpoint kinase 1; FPR,
false-positive rate; TPR, true-positive rate; TPM, transcripts per
million.

Figure 5

Reverse transcription-quantitative
PCR results of CHEK1 expression in high-grade
gastroenteropancreatic neuroendocrine neoplasms. (A) Comparison of
relative CHEK1 mRNA expression levels between the NET G3
(n=8) and NEC (n=26) groups. (B) Comparison of relative
CHEK1 mRNA expression levels among the NET G3 (n=8), LCNEC
(n=11) and SCNEC (n=15) subgroups. (C) Association between
CHEK1 expression status and histological types in NET G3 and
NEC. (D) Association between CHEK1 expression status and
histological types in NET G3, LCNEC and SCNEC.
*P<0.05 and **P<0.01. NET G3,
neuroendocrine tumour grade 3; NEC, neuroendocrine carcinoma;
LCNEC, large cell NEC; SCNEC, small cell NEC; CHEK1,
checkpoint kinase 1; ns, not significant.

Figure 6

Prognostic and diagnostic value of
CHEK1 in HG-GEP NENs. (A) Kaplan-Meier analysis of overall
survival in patients with HG-GEP NENs with high (n=14) vs. low
(n=20) CHEK1 expression (P=0.8464). (B) ROC curve analysis
of CHEK1 expression for distinguishing NEC from NET G3
(AUC=0.8029). (C) ROC curves of CHEK1 expression for
distinguishing LCNEC (AUC=0.7102) and SCNEC (AUC=0.8708) subtypes
from the NET G3 group. HG-GEP NENs, high-grade
gastroenteropancreatic neuroendocrine neoplasms; ROC, receiver
operating characteristic; AUC, area under the curve; CHEK1,
checkpoint kinase 1; NEC, neuroendocrine carcinoma; SCNEC, small
cell NEC; LCNEC, large cell NEC.
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Copy and paste a formatted citation
Spandidos Publications style
Li N, An J and Hu Y: Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms. Exp Ther Med 31: 6, 2026.
APA
Li, N., An, J., & Hu, Y. (2026). Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms. Experimental and Therapeutic Medicine, 31, 6. https://doi.org/10.3892/etm.2025.13001
MLA
Li, N., An, J., Hu, Y."Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms". Experimental and Therapeutic Medicine 31.1 (2026): 6.
Chicago
Li, N., An, J., Hu, Y."Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms". Experimental and Therapeutic Medicine 31, no. 1 (2026): 6. https://doi.org/10.3892/etm.2025.13001
Copy and paste a formatted citation
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Spandidos Publications style
Li N, An J and Hu Y: Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms. Exp Ther Med 31: 6, 2026.
APA
Li, N., An, J., & Hu, Y. (2026). Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms. Experimental and Therapeutic Medicine, 31, 6. https://doi.org/10.3892/etm.2025.13001
MLA
Li, N., An, J., Hu, Y."Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms". Experimental and Therapeutic Medicine 31.1 (2026): 6.
Chicago
Li, N., An, J., Hu, Y."Diagnostic significance of the checkpoint kinase 1 gene in high‑grade gastroenteropancreatic neuroendocrine neoplasms". Experimental and Therapeutic Medicine 31, no. 1 (2026): 6. https://doi.org/10.3892/etm.2025.13001
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