Aktypis Charalampos, Yavropoulou Maria P, Efstathopoulos Efstathios, Polichroniadi Despina, Poulia Kalliopi Anna, Papatheodoridis George, Kaltsas Gregory
Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
Εndocrinology Unit, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Endocrine. 2025 Apr;88(1):348-358. doi: 10.1007/s12020-024-04140-4. Epub 2024 Dec 30.
Neuroendocrine neoplasms (NEN) are rare tumors arising from neuroendocrine cells most commonly in the gastrointestinal-tract. In recent years, advancements in therapeutics have increased survival rates in patients with NEN leading to a greater clinical burden compared to the general population.
The aim of this single-center case-control study was to investigate the incidence of low bone mass and changes in body composition in adult patients diagnosed with gastroenteropancreatic neuroendocrine tumors (GEPNET). Enrolled participants underwent measurements of bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) and body composition analysis with calculation of total fat-mass (TFM) and relative skeletal mass index (RSMI), by dual X-ray absorptiometry.
Ninety GEPNET patients (28 with Pancreatic-NET, 20 with small-intestine-NET, 42 with gastric-NET), and 50 age and sex-matched controls were enrolled. The mean disease duration was 5±4.4 years, the majority of patients (54/90) was classified as stage-1, and were not receiving systemic-treatment (76/90). The incidence of osteoporosis/osteopenia was threefold higher in the patients' cohort, compared to controls (OR: 3.17 95% CI 1.16-7.8, p < 0.001). Among NEN patients, gastric-NET had the lowest bone mass, especially in LS. In addition, GEPNET patients demonstrated significantly lower TFM and RSMI, compared to controls (TFM: 31.6 ± 9.6 kg vs. 38.6 ± 6.4 kg, respectively, p = 0.03; RSMI: 6.4 ± 1.1 vs. 8.2 ± 0.6, respectively, p < 0.001). Within our patients' cohort, RSMI was significantly associated with LS-BMD (rho = 0.49, p < 0.001) and TH-BMD (rho = 0.58, p < 0.001), and TFM was associated with TH-BMD (rho = 0.31, p = 0.004).
Patients with GEPNET even at an early stage exhibit significantly lower bone, muscle and fat mass compared to the non-NET population, highlighting the importance of continuous monitoring of the musculoskeletal system in these patients.
神经内分泌肿瘤（NEN）是起源于神经内分泌细胞的罕见肿瘤，最常见于胃肠道。近年来，治疗方法的进步提高了NEN患者的生存率，与普通人群相比，导致了更大的临床负担。
本单中心病例对照研究的目的是调查诊断为胃肠胰神经内分泌肿瘤（GEPNET）的成年患者低骨量的发生率和身体成分的变化。纳入的参与者通过双能X线吸收法测量腰椎（LS）、股骨颈（FN）和全髋（TH）的骨密度（BMD），并进行身体成分分析，计算总脂肪量（TFM）和相对骨骼质量指数（RSMI）。
纳入了90例GEPNET患者（28例胰腺神经内分泌肿瘤、20例小肠神经内分泌肿瘤、42例胃神经内分泌肿瘤）和50例年龄和性别匹配的对照。平均病程为5±4.4年，大多数患者（54/90）被分类为1期，且未接受全身治疗（76/90）。与对照组相比，患者队列中骨质疏松/骨量减少的发生率高出三倍（OR：3.17，95%CI 1.16-7.8，p<0.001）。在NEN患者中，胃神经内分泌肿瘤的骨量最低，尤其是在腰椎。此外，与对照组相比，GEPNET患者的TFM和RSMI显著降低（TFM分别为31.6±9.6kg和38.6±6.4kg，p=0.03；RSMI分别为6.4±1.1和8.2±0.6，p<0.001）。在我们的患者队列中，RSMI与LS-BMD（rho=0.49，p<0.001）和TH-BMD（rho=0.58，p<0.001）显著相关，TFM与TH-BMD相关（rho=0.31，p=0.004）。
与非NET人群相比，即使处于早期阶段的GEPNET患者的骨、肌肉和脂肪量也显著降低，这突出了对这些患者持续监测肌肉骨骼系统的重要性。
