Clinical outcomes in patients with neuroendocrine tumors and concomitant protein energy malnutrition.

Abstract

e24057 Background: Neuroendocrine tumors are slow-growing tumors commonly found in the gastrointestinal tract. Diagnosis is often delayed as patients present either asymptomatically or with non-specific symptoms. Patients with neuroendocrine tumors are at risk for protein-energy malnutrition (PEM) either from treatment with surgery and/or chemoradiation or from the cancer itself. Data on the impact of this PEM in patients with neuroendocrine tumors is limited. Methods: A retrospective cohort study was conducted using the TriNetX platform to compare outcomes between patients with PEM (Cohort 1, N = 2,531) and those without PEM (Cohort 2, N = 2,531). Patients aged ≥18 years with diagnosis of malignant neuroendocrine tumors (ICD-10: C7A) were included. PEM was defined by ICD-10 codes for severe protein-calorie malnutrition (E43) or moderate/mild protein-calorie malnutrition (E44). Outcome measures included all-cause mortality, cardiogenic shock, acute renal failure, intubation, sepsis, severe sepsis, and septic shock. Outcomes were analyzed over a 10-year period beginning one day post-index event. Propensity score matching ensured balance in baseline characteristics between cohorts. Statistical analyses included risk difference, relative risk (RR), odds ratio (OR), and Kaplan-Meier survival estimates. Results: The PEM cohort exhibited significantly higher risks for adverse outcomes. All-cause mortality occurred in 56.5% of Cohort 1 compared to 33.2% of Cohort 2 (risk difference 23.4%, RR = 1.705, OR = 2.622; p < 0.001). Risks for sepsis were also elevated in the PEM cohort (17.3% vs. 12.3%; risk difference 5.0%, RR = 1.410, OR = 1.496; p < 0.001). Severe sepsis and septic shock showed pronounced differences: severe sepsis occurred in 6.3% of Cohort 1 versus 3.5% of Cohort 2 (risk difference 2.7%, RR = 1.778, OR = 1.830; p < 0.001), while septic shock occurred in 8.2% versus 4.6% (risk difference 3.7%, RR = 1.810, OR = 1.882; p < 0.001). Intubation rates were substantially higher in the PEM cohort (6.9% vs. 3.0%; risk difference 3.9%, RR = 2.274, OR = 2.369; p < 0.001). While risks for cardiogenic shock (RR = 1.130, p = 0.534) and acute renal failure (RR = 1.261, p = 0.203) were higher in the PEM group, these differences were not statistically significant. Kaplan-Meier survival analysis confirmed significantly reduced survival probabilities for the PEM cohort. Across all metrics, patients with PEM demonstrated worse health outcomes and higher complication rates. Conclusions: Our analysis demonstrated that PEM among patients with neuroendocrine tumor is associated with increased risk of all-cause mortality, sepsis, severe sepsis, and septic shock. Intubation rates also were higher. Prevention of and early management of cancer-associated malnutrition is essential to prevent adverse outcomes. Additional longitudinal cohort studies are required to improve the understanding of this association.