Preoperative nutritional status and sarcopenia are associated with disease-free survival in patients with resected pancreatic neuroendocrine tumors

Background: Pancreatic neuroendocrine tumors (pNETs) show heterogeneous clinical behavior, and better predictors of postoperative recurrence are needed. Methods: We retrospectively analyzed 86 patients who underwent curative-intent resection for pNETs at a tertiary referral center. Preoperative nutritional status was assessed using the prognostic nutritional index (PNI), with a predefined literature-based cut-off of PNI < 50, and sarcopenia was defined on preoperative CT using L3 skeletal muscle index (SMI) and Prado sex-specific cut-offs. Disease-free survival (DFS) was evaluated using Kaplan-Meier methods and Cox regression. Results: Over a median follow-up of 21.8 months (IQR 7.7-37.2), 21 patients (24.4%) developed recurrence or progression. Sarcopenia was present in 47 patients (54.7%) and low PNI in 50 patients (58.1%), with 32 patients (37.2%) meeting both criteria. Sarcopenia was associated with shorter DFS (log-rank P = 0.034) and a higher hazard of recurrence in univariable analysis. After adjustment in a parsimonious multivariable model, this association was attenuated and no longer statistically significant. Conclusions: Preoperative CT-defined sarcopenia was associated with DFS in resected pNETs, but its independence from tumor burden remains uncertain and should be tested in larger prospective multicenter studies using standardized CT protocols.