Salute muscolo-scheletrica ed implicazioni prognostiche in una coorte di pazienti affetti da neoplasie neuroendocrine

Abstract

Background:L’impatto dei tumori neuroendocrini (NET) sulla salute muscoloscheletrica rimane inconclusivo. Obiettivo:Valutare la salute muscoloscheletrica nei pazienti con NET, esplorarne il valore prognostico e l’associazione con l'aggressività tumorale. Materiali e metodi:In questo studio cross-sectional. 41 pazienti con NET polmonari e gastroenteropancreatici G1,2,3, di cui 38 confrontati con 47 controlli sani (CS) comparabili per età, sesso e BMI, venivano sottoposti all’analisi DXA (Dual-Energy X-ray Absorptiometry). Risultati:I pazienti NET presentavano un TBS (trabecular bone score) degradato,osteopenia del collo femorale,ipovitaminosi D e RSMI (relative skeletal muscle index) suggestivo di sarcopenia, rispettivamente nel 71%,59%,68% e 37% dei casi. Lo stadio avanzato del NET si associava a BMD, T-score e Z-score lombari, 25-OHvitamina D [25(OH)D] e BMI inferiori.I NET G2 vs G1 presentavano valori ridotti di BMD L1-L4 e diafisaria e T-score L1-L4 e dell'intero femore. All’analisi multivariata¸ 25(OH)D e BMI superiori si associavano a PFS (progression-free survival) migliore, mentre un Ki-67 maggiore a PFS inferiore.Inoltre, Ki-67 correlava con T-score dell'intero femore e BMD diafisaria inferiori;l'età alla diagnosi con indici ossei peggiori, mentre un BMI superiore con migliori indici ossei e RSMI.Rispetto ai CS, i pazienti NET presentavano un TBS significativamente inferiore, nonostante BMD, T-score o Z-score. Conclusioni:I pazienti NET mostravano una sostanziale compromissione muscolo-scheletrica, con TBS inferiore vs CS nonostante BMD. Stadio avanzato e grado tumorale elevato si associavano a peggiore salute ossea.Livelli superiori di 25(OH)D e BMI emergevano come predittori indipendenti di PFS migliore,supportando una possibile relazione tra stato nutrizionale-metabolico e prognosi del NET. Questi risultati esplorativi evidenziano la necessità di una valutazione muscoloscheletrica strutturata nei NET e richiedono validazione in studi prospettici più ampi.

Background:The impact of neuroendocrine tumors (NETs) on musculoskeletal health remains inconclusive. Aim:To assess musculoskeletal health in NET patients and to explore its prognostic relevance and its association with tumor aggressiveness. Materials and methods:In this cross-sectional study, 41 patients with G1,G2,G3 pulmonary and gastroenteropancreatic NETs,38 of whom were compared with 47 healthy controls (CT) matched for age,sex, and BMI, underwent DXA (Dual-Energy X-ray Absorptiometry) analysis. Results:NET patients presented degraded TBS (trabecular bone score),femoral neck osteopenia, hypovitaminosis D, and reduced RSMI (relative skeletal muscle index) suggestive of sarcopenia in 71%,59%,68%, and 37% of cases,respectively. Advanced NET stage was associated with lower lumbar BMD (bone mineral density),T-score,Z-score,25-hydroxyvitamin D [25(OH)D],and BMI. G2 NETs presented reduced L1-L4 and diaphyseal BMD, as well as L1-L4 and total hip T-score,compared to G1. In multivariate analysis, higher 25(OH)D and BMI were independently associated with better PFS (progression-free survival), while a higher Ki-67 was associated with worse PFS. Moreover,Ki-67 correlated inversely with total hip T-score and diaphyseal BMD; age at diagnosis correlated with worse bone parameters, while a higher BMI correlated with better bone indices and RSMI. Compared to CT, NET patients presented a significantly lower TBS, despite BMD, T-score,or Z-score. Conclusions:NET patients showed substantial musculoskeletal impairment, with a significantly lower TBS vs CT, despite BMD values. Advanced stage and high tumor grade were associated with worse bone health. Higher levels of 25(OH)D and BMI emerged as independent predictors of higher PFS,supporting a potential relationship between nutritional-metabolic status and NET prognosis. These exploratory results highlight the need for a structured musculoskeletal assessment in NET patients and warrant validation in larger prospective studies.