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.