Background and aims: Nutritional status is a critical yet underexplored factor in retroperitoneal sarcoma (RPS) care. Traditional anthropometric indicators such as BMI are unreliable in this setting due to tumorrelated weight masking. This study aimed to assess the prognostic impact of preoperative nutritional status in RPS patients using the Prognostic Nutritional Index (PNI) and Skeletal Muscle Index (SMI). Methods: A retrospective cohort study was conducted on 250 RPS patients treated at a high-volume sarcoma centre between 2010 and 2023. Nutritional status was assessed preoperatively via PNI (malnutrition) and CT-derived SMI (sarcopenia). Associations with postoperative complications and oncological outcomes were analysed using logistic and Cox regression models. Results: Malnutrition and sarcopenia were observed in 50.2 % and 53.2 % of patients, respectively. BMI did not correlate with either PNI or SMI. Malnutrition, but not sarcopenia, was independently associated with increased severe postoperative complications (OR 2.128, p = 0.021). On survival analysis, malnutrition was significantly associated with reduced overall survival (OS) in both primary (HR 1.762, p = 0.043) and recurrent (HR 4.000, p = 0.001) tumors. Among patients with favorable Sarculatorderived prognosis (5-year OS >= 60 %), malnutrition stratified survival outcomes (log-rank p = 0.044). Conversely, in poor-prognosis patients (Sarculator <60 %), the impact of malnutrition was not statistically significant. SMI correlated with OS as a continuous variable (p = 0.043), but predefined sarcopenia thresholds failed to predict outcomes. Conclusion: PNI is a reliable and accessible tool for identifying malnutrition and predicting outcomes in RPS patients. Integration of nutritional assessment into preoperative pathways and the development of RPS-specific SMI cut-offs may improve risk stratification and patient management. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
Nutritional status in retroperitoneal sarcoma: Implication of prognostic Nutritional Index (PNI) and skeletal muscle index (SMI) on postoperative and oncological outcomes
Levi, Riccardo;Cananzi, Ferdinando C M
2025-01-01
Abstract
Background and aims: Nutritional status is a critical yet underexplored factor in retroperitoneal sarcoma (RPS) care. Traditional anthropometric indicators such as BMI are unreliable in this setting due to tumorrelated weight masking. This study aimed to assess the prognostic impact of preoperative nutritional status in RPS patients using the Prognostic Nutritional Index (PNI) and Skeletal Muscle Index (SMI). Methods: A retrospective cohort study was conducted on 250 RPS patients treated at a high-volume sarcoma centre between 2010 and 2023. Nutritional status was assessed preoperatively via PNI (malnutrition) and CT-derived SMI (sarcopenia). Associations with postoperative complications and oncological outcomes were analysed using logistic and Cox regression models. Results: Malnutrition and sarcopenia were observed in 50.2 % and 53.2 % of patients, respectively. BMI did not correlate with either PNI or SMI. Malnutrition, but not sarcopenia, was independently associated with increased severe postoperative complications (OR 2.128, p = 0.021). On survival analysis, malnutrition was significantly associated with reduced overall survival (OS) in both primary (HR 1.762, p = 0.043) and recurrent (HR 4.000, p = 0.001) tumors. Among patients with favorable Sarculatorderived prognosis (5-year OS >= 60 %), malnutrition stratified survival outcomes (log-rank p = 0.044). Conversely, in poor-prognosis patients (Sarculator <60 %), the impact of malnutrition was not statistically significant. SMI correlated with OS as a continuous variable (p = 0.043), but predefined sarcopenia thresholds failed to predict outcomes. Conclusion: PNI is a reliable and accessible tool for identifying malnutrition and predicting outcomes in RPS patients. Integration of nutritional assessment into preoperative pathways and the development of RPS-specific SMI cut-offs may improve risk stratification and patient management. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
