title: Malnutrition Predicts Clinical Outcome in Patients with Neuroendocrine Neoplasia.
abstract: Malnutrition is a common problem in oncological diseases, influencing treatment outcomes, treatment complications, quality of life and survival. The potential role of malnutrition has not yet been studied systematically in neuroendocrine neoplasms (NEN), which, due to their growing prevalence and additional therapeutic options, provide an increasing clinical challenge to diagnosis and management. The aim of this cross-sectional observational study, which included a long-term follow-up, was therefore to define the prevalence of malnutrition in 203 patients with NEN using various methodological approaches, and to analyse the short- and long-term outcome of malnourished patients. A detailed subgroup analysis was also performed to define risk factors for poorer outcome. When applying malnutrition screening scores, 21-25% of the NEN patients were at risk of or demonstrated manifest malnutrition. This was confirmed by anthropometric measurements, by determination of serum surrogate parameters such as albumin as well as by bioelectrical impedance analysis (BIA), particularly phase angle α. The length of hospital stay was significantly longer in malnourished NEN patients, while long-term overall survival was highly significantly reduced. Patients with high-grade (G3) neuroendocrine carcinomas, progressive disease and undergoing chemotherapy were at particular risk of malnutrition associated with a poorer outcome. Multivariate analysis confirmed the important and highly significant role of malnutrition as an independent prognostic factor for NEN besides proliferative capacity (G3 NEC). Malnutrition is therefore an underrecognized problem in NEN patients which should systematically be diagnosed by widely available standard methods such as Nutritional Risk Screening (NRS), serum albumin assessment and BIA, and treated to improve both short- and long-term outcomes.
authors.affiliation: Department of Hepatology and Gastroenterology, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Maasberg
authors.forename: Barbora
authors.initials: B
authors.lastname: Knappe-Drzikova
authors.forename: Dorothée
authors.initials: D
authors.lastname: Vonderbeck
authors.forename: Henning
authors.initials: H
authors.lastname: Jann
authors.forename: Karsten H
authors.initials: KH
authors.lastname: Weylandt
authors.forename: Christian
authors.initials: C
authors.lastname: Grieser
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Schefold
authors.forename: Marianne
authors.initials: M
authors.lastname: Pavel
authors.forename: Bertram
authors.initials: B
authors.lastname: Wiedenmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Sturm
authors.forename: Ulrich-Frank
authors.initials: UF
authors.lastname: Pape
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D001823:Body Composition; D002648:Child; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014168:Transferrin / Q000378:metabolism; D055815:Young Adult
chemical_list: D012709:Serum Albumin; D014168:Transferrin