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Romano E, Polici M, Marasco M, Lerose F, Dell’Unto E, Nardacci S, Zerunian M, Iannicelli E, Rinzivillo M, Laghi A, Annibale B, Panzuto F, Caruso D. Sarcopenia in Patients with Advanced Gastrointestinal Well-Differentiated Neuroendocrine Tumors. Nutrients 2024; 16:2224. [PMID: 39064666 PMCID: PMC11279441 DOI: 10.3390/nu16142224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Neuroendocrine neoplasms (NENs) are slow-growing tumors. Sarcopenia is defined as the loss of muscle mass, strength, and physical performance. First-line NEN therapy is somatostatin analogs, which could be responsible for malabsorption conditions, such as pancreatic exocrine insufficiency (EPI) with underlying sarcopenia. AIM Evaluate the prevalence of sarcopenia in patients with NENs at diagnosis and during follow-up. METHODS A retrospective single-center study was conducted, including patients with advanced intestinal NENs G1/G2 (excluded pancreatic NENs). CT scans were analyzed at diagnosis and after 6 months of therapy, and the skeletal muscle index was assessed. RESULTS A total of 30 patients (F:M = 6:24) were enrolled, with the following primary tumor sites: 25 in the ileum, 1 stomach, 2 jejunum, and 2 duodenum. At diagnosis, 20 patients (66.6%) showed sarcopenic SMI values, and 10 patients (33.3%) showed non-sarcopenic SMI values. At follow-up, three more patients developed sarcopenic SMI values. Statistical significance in relation to the presence of sarcopenia was found in the group of patients with carcinoid syndrome (p = 0.0178), EPI (p = 0.0018), and weight loss (p = 0.0001). CONCLUSION Sarcopenia was present in 2/3 of the patients with advanced intestinal NENs at the diagnosis and during the follow-up. It is reasonable to consider this condition to improve clinical outcomes.
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Affiliation(s)
- Elena Romano
- Digestive Disease Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (E.R.); (M.M.); (F.L.); (E.D.); (M.R.); (B.A.)
| | - Michela Polici
- Radiology Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (M.P.); (S.N.); (M.Z.); (E.I.); (A.L.); (D.C.)
- PhD School in Translational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Matteo Marasco
- Digestive Disease Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (E.R.); (M.M.); (F.L.); (E.D.); (M.R.); (B.A.)
- PhD School in Translational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesco Lerose
- Digestive Disease Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (E.R.); (M.M.); (F.L.); (E.D.); (M.R.); (B.A.)
| | - Elisabetta Dell’Unto
- Digestive Disease Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (E.R.); (M.M.); (F.L.); (E.D.); (M.R.); (B.A.)
| | - Stefano Nardacci
- Radiology Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (M.P.); (S.N.); (M.Z.); (E.I.); (A.L.); (D.C.)
| | - Marta Zerunian
- Radiology Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (M.P.); (S.N.); (M.Z.); (E.I.); (A.L.); (D.C.)
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Elsa Iannicelli
- Radiology Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (M.P.); (S.N.); (M.Z.); (E.I.); (A.L.); (D.C.)
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Maria Rinzivillo
- Digestive Disease Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (E.R.); (M.M.); (F.L.); (E.D.); (M.R.); (B.A.)
| | - Andrea Laghi
- Radiology Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (M.P.); (S.N.); (M.Z.); (E.I.); (A.L.); (D.C.)
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Bruno Annibale
- Digestive Disease Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (E.R.); (M.M.); (F.L.); (E.D.); (M.R.); (B.A.)
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Francesco Panzuto
- Digestive Disease Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (E.R.); (M.M.); (F.L.); (E.D.); (M.R.); (B.A.)
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Damiano Caruso
- Radiology Unit, Sant’ Andrea University Hospital, ENETS Center of Excellence, 00189 Rome, Italy; (M.P.); (S.N.); (M.Z.); (E.I.); (A.L.); (D.C.)
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
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McDonnell D, Afolabi PR, Wilding S, Griffiths GO, Swann JR, Byrne CD, Hamady ZZ. Utilising Pancreatic Exocrine Insufficiency in the Detection of Resectable Pancreatic Ductal Adenocarcinoma. Cancers (Basel) 2023; 15:5756. [PMID: 38136302 PMCID: PMC10741412 DOI: 10.3390/cancers15245756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed late, leading to a high mortality rate. Early detection facilitates better treatment options. The aim of this UK-based case-control study was to determine whether two validated tests for pancreatic exocrine insufficiency (PEI), namely, the 13C-mixed triglyceride breath test (13C-MTGBT) and a faecal elastase (FE-1) test, can discriminate between patients with resectable PDAC versus healthy volunteers (HVs) along with a comparison group with chronic pancreatitis (CP). Discrimination between disease states and HVs was tested with receiver operator characteristic (ROC) curves. In total, 59 participants (23 PDAC (16 men), 24 HVs (13 men) and 12 CP (10 men)) were recruited, with a similar age in each population, and a combined median (IQR) age of 66 (57-71). The areas under the ROC curve for discriminating between PDAC and HVs were 0.83 (95% CI: 0.70-0.96) for the 13C-MTGBT, and 0.85 (95% CI: 0.75-0.95) for the FE-1 test. These were similar to CP vs. HV. In conclusion, PEI occurs in resectable PDAC to a similar extent as in CP; further large-scale, prospective studies using these tests in the primary care setting on high-risk groups are warranted.
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Affiliation(s)
- Declan McDonnell
- Human Development & Health, University of Southampton, Southampton SO16 6YD, UK; (P.R.A.); (Z.Z.H.)
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Paul R. Afolabi
- Human Development & Health, University of Southampton, Southampton SO16 6YD, UK; (P.R.A.); (Z.Z.H.)
| | - Sam Wilding
- Cancer Research UK Southampton Clinical Trials Unit, University of Southampton, Southampton SO17 1BJ, UK
| | - Gareth O. Griffiths
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Cancer Research UK Southampton Clinical Trials Unit, University of Southampton, Southampton SO17 1BJ, UK
| | - Jonathan R. Swann
- Human Development & Health, University of Southampton, Southampton SO16 6YD, UK; (P.R.A.); (Z.Z.H.)
| | - Christopher D. Byrne
- Human Development & Health, University of Southampton, Southampton SO16 6YD, UK; (P.R.A.); (Z.Z.H.)
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Zaed Z. Hamady
- Human Development & Health, University of Southampton, Southampton SO16 6YD, UK; (P.R.A.); (Z.Z.H.)
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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