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Phenotyping in clinical nutrition

Computed tomography (CT)-defined sarcopenia and myosteatosis are prevalent in patients with neuroendocrine neoplasms (NENs) treated with peptide receptor radionuclide therapy (PRRT)



Neuroendocrine neoplasms (NEN) may predispose patients to malnutrition. CT-defined sarcopenia and myosteatosis are common in other tumour types and recognized adverse prognostic factors. However, the prevalence and prognostic impact of sarcopenia and myosteatosis remain undetermined in NEN patients to date.


A retrospective study of NEN patients treated with peptide receptor radionuclide therapy (PRRT) at a tertiary institution from 2012 to 2017. Patients with PET/CT imaging at baseline and follow-up were included. The L3 slice of the co-localizing CT was analysed using the Alberta Protocol. Skeletal muscle cross-sectional area and muscle attenuation were measured and compared with pre-defined cut-offs. The primary endpoint was the prevalence of sarcopenia and myosteatosis according to previously published cut-offs.


Fourty-nine patients (median age 64 (range 26–80) years) were included. The most common primary sites of tumour were the small bowel (51%) and pancreas (26%). Baseline sarcopenia was prevalent in 67% of patients and myosteatosis in 71%. Forty-five percent of patients gained weight over the course of PRRT. The presence of baseline sarcopenia was not associated with progression-free survival (20.8 mo vs. 20.7 mo, HR 0.86, p = 0.70) nor overall survival. Similarly, baseline myosteatosis (PFS 19.5 mo vs. 20.8 mo, HR 0.77, p = 0.47) was not significantly associated with survival outcomes. The mean (SD) age of those with myosteatosis was 60.8 ± 11.6 years compared to 49.7 ± 12.7 years for those without (p = 0.003).


Body composition analysis is feasible using routinely acquired PET/CT data for patients with NEN. CT-defined sarcopenia and myosteatosis are prevalent in NEN patients, although myosteatosis is more common with increasing age. These findings were not associated with worsened overall or progression-free survival in the current study.

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Fig. 1: Summary of body composition analysis method.


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Authors and Affiliations



DLC, SJC and MF participated in study conception, design and acquisition/analysis of the data. All authors were involved in interpretation of the data, critical revision of the manuscript and approval of the submitted version.

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Correspondence to David L. Chan.

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Conflict of interest

DLC has received honoraria and travel support from Novartis and Ipsen, outside the scope of the submitted work. NP has received honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Roche Pharma AG, Merck Serono and Ipsen and has consulted for Merck Serono, Amgen, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Pfizer, Novartis, Roche Pharma AG, Ipsen, Merck, Baxalta, Specialised Therapeutics and AstraZeneca, outside the scope of the submitted work.

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Chan, D.L., Clarke, S.J., Engel, A. et al. Computed tomography (CT)-defined sarcopenia and myosteatosis are prevalent in patients with neuroendocrine neoplasms (NENs) treated with peptide receptor radionuclide therapy (PRRT). Eur J Clin Nutr 76, 143–149 (2022).

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