Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

Malnutrition Predicts Clinical Outcome in Patients with Neuroendocrine Neoplasia

Maasberg S.a · Knappe-Drzikova B.a · Vonderbeck D.a · Jann H.a · Weylandt K.H.a · Grieser C.c · Pascher A.d · Schefold J.C.e · Pavel M.a · Wiedenmann B.a · Sturm A.a, f · Pape U.-F.a

Author affiliations

aDepartment of Hepatology and Gastroenterology, Campus Charité Mitte and Campus Virchow-Klinikum, and bInstitute of Radiology and Departments of cRadiology, dGeneral, Visceral and Transplantation Surgery and eNephrology and Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, and fDepartment of Internal Medicine, DRK-Kliniken Westend, Berlin, Germany

Related Articles for ""

Neuroendocrinology 2017;104:11-25

Do you have an account?

Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 14, 2015
Accepted: November 30, 2015
Published online: December 08, 2015
Issue release date: November 2016

Number of Print Pages: 15
Number of Figures: 6
Number of Tables: 6

ISSN: 0028-3835 (Print)
eISSN: 1423-0194 (Online)

For additional information: https://www.karger.com/NEN

Abstract

Malnutrition is a common problem in oncological diseases, influencing treatment outcomes, treatment complications, quality of life and survival. The potential role of malnutrition has not yet been studied systematically in neuroendocrine neoplasms (NEN), which, due to their growing prevalence and additional therapeutic options, provide an increasing clinical challenge to diagnosis and management. The aim of this cross-sectional observational study, which included a long-term follow-up, was therefore to define the prevalence of malnutrition in 203 patients with NEN using various methodological approaches, and to analyse the short- and long-term outcome of malnourished patients. A detailed subgroup analysis was also performed to define risk factors for poorer outcome. When applying malnutrition screening scores, 21-25% of the NEN patients were at risk of or demonstrated manifest malnutrition. This was confirmed by anthropometric measurements, by determination of serum surrogate parameters such as albumin as well as by bioelectrical impedance analysis (BIA), particularly phase angle α. The length of hospital stay was significantly longer in malnourished NEN patients, while long-term overall survival was highly significantly reduced. Patients with high-grade (G3) neuroendocrine carcinomas, progressive disease and undergoing chemotherapy were at particular risk of malnutrition associated with a poorer outcome. Multivariate analysis confirmed the important and highly significant role of malnutrition as an independent prognostic factor for NEN besides proliferative capacity (G3 NEC). Malnutrition is therefore an underrecognized problem in NEN patients which should systematically be diagnosed by widely available standard methods such as Nutritional Risk Screening (NRS), serum albumin assessment and BIA, and treated to improve both short- and long-term outcomes.

© 2015 S. Karger AG, Basel


References

  1. Coats KG, Morgan SL, Bartolucci AA, Weinsier RL: Hospital-associated malnutrition: a reevaluation 12 years later. J Am Diet Assoc 1993;93:27-33.
  2. McWhirter JP, Pennington CR: Incidence and recognition of malnutrition in hospital. BMJ 1994;308:945-948.
  3. Edington J, Boorman J, Durrant ER, Perkins A, Giffin CV, James R, Thomson JM, Oldroyd JC, Smith JC, Torrance AD, Blackshaw V, Green S, Hill CJ, Berry C, McKenzie C, Vicca N, Ward JE, Coles SJ: Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group. Clin Nutr 2000;19:191-195.
  4. Kyle UG, Pirlich M, Schütz T, Lübke HJ, Lochs H, Pichard C: Prevalence of malnutrition in 1,760 patients at hospital admission: a controlled population study of body composition. Clin Nutr 2003;22:473-481.
  5. Pirlich M, Schütz T, Kemps M, Luhman N, Burmester GR, Baumann G, Plauth M, Lübke HJ, Lochs H: Prevalence of malnutrition in hospitalized medical patients: impact of underlying disease. Dig Dis 2003;21:245-251.
  6. Ockenga J, Freudenreich M, Zakonsky R, Norman K, Pirlich M, Lochs H: Nutritional assessment and management in hospitalised patients: implication for DRG-based reimbursement and health care quality. Clin Nutr 2005;24:913-919.
  7. Pirlich M, Schütz T, Norman K, Gastell S, Lübke HJ, Bischoff SC, Bolder U, Frieling T, Güldenzoph H, Hahn K, Jauch KW, Schindler K, Stein J, Volkert D, Weimann A, Werner H, Wolf C, Zürcher G, Bauer P, Lochs H: The German hospital malnutrition study. Clin Nutr 2006;25:563-572.
  8. Norman K, Pichard C, Lochs H, Pirlich M: Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27:5-15.
  9. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE: Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011;12:489-495.
  10. Bozzetti F, Mariani L, Lo Vullo S; SCRINIO Working Group, Amerio ML, Biffi R, Caccialanza G, Capuano G, Correja I, Cozzaglio L, Di Leo A, Di Cosmo L, Finocchiaro C, Gavazzi C, Giannoni A, Magnanini P, Mantovani G, Pellegrini M, Rovera L, Sandri G, Tinivella M, Vigevani E: The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer 2012;20:1919-1928.
  11. Jagoe RT, Goodship TH, Gibson GJ: Nutritional status of patients undergoing lung cancer operations. Ann Thorac Surg 2001;71:929-935.
  12. Gupta D, Lammersfeld CA, Vashi PG, King J, Dahlk SL, Grutsch JF, Lis CG: Bioelectrical impedance phase angle in clinical practice: implications for prognosis in stage IIIB and IV non-small cell lung cancer. BMC Cancer 2009;9:37-42.
  13. Rey-Ferro M, Castaño R, Orozco O, Serna A, Moreno A: Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition 1997;13:878-881.
  14. Andreyev HJN, Norman AR, Oates J, Cunningham D: Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 1998;35:503-509.
  15. Gupta D, Lis CG, Dahlk SL, Vashi PG, Grutsch JF, Lammersfeld CA: Bioelectrical impedance phase angle as a prognostic indicator in advanced pancreatic cancer. Br J Nutr 2004;92:957-962.
  16. Segura A, Pardo J, Jara C, Zugazabeitia L, Carulla J, de Las Peñas R, García-Cabrera E, Luz Azuara M, Casadó J, Gómez-Candela C: An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer. Clin Nutr 2005;24:801-814.
  17. Gupta D, Lis CG, Dahlk SL, King J, Vashi PG, Grutsch JF, Lammersfeld CA: The relationship between bioelectrical impedance phase angle and subjective global assessment in advanced colorectal cancer. Nutr J 2008;7:19-25.
  18. Laky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A: Malnutrition among gynaecological cancer patients. Eur J Clin Nutr 2007;61:642-646.
  19. Laky B, Janda M, Cleghorn G, Obermair A: Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr 2008;87:1678-1685.
    External Resources
  20. Gupta D, Lammersfeld CA, Vashi PG, Dahlk SL, Lis CG: Can subjective global assessment of nutritional status predict survival in ovarian cancer? J Ovarian Res 2008;1:5-11.
  21. Haydock DA, Hill GL: Impaired wound healing in surgical patients with varying degrees of malnutrition. JPEN J Parenter Enteral Nutr 1986;10:550-554.
  22. Jagoe RT, Goodship TH, Gibson GJ: The influence of nutritional status on complications after operations for lung cancer. Ann Thorac Surg 2001;71:936-943.
  23. Kyle UG, Pirlich M, Lochs H, Schütz T, Pichard C: Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study. Clin Nutr 2005;24:133-142.
  24. Kyle UG, Schneider SM, Pirlich M, Lochs H, Hebuterne X, Pichard C: Does nutritional risk, as assessed by Nutritional Risk Index, increase during hospital stay? A multinational population-based study. Clin Nutr 2005;24:516-524.
  25. Gupta D, Lammersfeld CA, Vashi PG, Burrows J, Lis CG, Grutsch JF: Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr 2005;59:35-40.
  26. August DA, Huhmann MB; American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors: A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr 2009;33:472-500.
  27. Bozzetti F, Arends J, Lundholm K, Micklewright A, Zürcher G, Muscaritoli M: ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr 2009;28:445-454.
  28. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, Abdalla EK, Fleming JB, Vauthey JN, Rashid A, Evans DB: One hundred years after ‘carcinoid': epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008;26:3063-3072.
  29. Modlin IM, Oberg K, Chung DC, Jensen RT, de Herder WW, Thakker RV, Caplin M, Delle Fave G, Kaltsas GA, Krenning EP, Moss SF, Nilsson O, Rindi G, Salazar R, Ruszniewski P, Sundin A: Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol 2008;9:61-72.
  30. Rindi G, Wiedenmann B: Neuroendocrine neoplasms of the gut and the pancreas: new insights. Nat Rev Endocrinol 2011;8:54-64.
  31. Maschmeyer G, Mügge LO, Kämpfe D, Kreibich U, Wilhelm S, Assmann M, Schwarz M, Kahl C, Köhler S, Grobe N, Niederwieser D: A retrospective review of diagnosis and treatment modalities of neuroendocrine tumors (excluding primary lung cancer) in 10 oncological institutions of the East German Study Group of Hematology and Oncology (OSHO), 2010-2012. J Cancer Res Clin Oncol 2015;141:1639-1644.
  32. Pape UF, Berndt U, Müller-Nordhorn J, Böhmig M, Roll S, Koch M, Willich SN, Wiedenmann B: Prognostic factors of long-term outcome in gastroenteropancreatic neuroendocrine tumours. Endocr Relat Cancer 2008;15:1083-1097.
  33. Klöppel G, Perren A, Heitz PU: The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification. Ann NY Acad Sci 2014;1014:13-27.
  34. Ekeblad S, Skogseid B, Dunder K, Oberg K, Eriksson B: Prognostic factors and survival in 324 patients with pancreatic endocrine tumor treated at a single institution. Clin Cancer Res 2008;14:7798-7803.
  35. Pape UF, Jann H, Müller-Nordhorn J, Bockelbrink A, Berndt U, Willich SN, Koch M, Röcken C, Rindi G, Wiedenmann B: Prognostic relevance of a novel TNM classification system for upper gastroenteropancreatic neuroendocrine tumors. Cancer 2008;113:256-265.
  36. Jann H, Roll S, Couvelard A, Hentic O, Pavel M, Müller-Nordhorn J, Koch M, Röcken C, Rindi G, Ruszniewski P, Wiedenmann B, Pape UF: Neuroendocrine tumors of midgut and hindgut origin: tumor-node-metastasis classification determines clinical outcome. Cancer 2011;117:3332-3341.
  37. Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B: TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study. J Natl Cancer Inst 2012;104:764-777.
  38. Sobin LH, Gospodarowicz MK, Wittekind C (eds): TNM Classification of Malignant Tumours. Hoboken, Wiley & Blackwell, 2009.
  39. O'Toole D, Grossman A, Gross D, Delle Fave G, Barkmanova J, O'Connor J, Pape UF, Plöckinger U: ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: biochemical markers. Neuroendocrinology 2009;90:194-202.
  40. Pape UF, Perren A, Niederle B, Gross D, Gress T, Costa F, Arnold R, Denecke T, Plöckinger U, Salazar R, Grossman A: ENETS Consensus Guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas. Neuroendocrinology 2012;95:135-156.
  41. Marrache F, Vullierme MP, Roy C, El Assoued Y, Couvelard A, O'Toole D, Mitry E, Hentic O, Hammel P, Lévy P, Ravaud P, Rougier P, Ruszniewski P: Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours. Br J Cancer 2007;96:49-55.
  42. Davies AH, Larsson G, Ardill J, Friend E, Jones L, Falconi M, Bettini R, Koller M, Sezer O, Fleissner C, Taal B, Blazeby JM, Ramage JK: Development of a disease-specific Quality of Life questionnaire module for patients with gastrointestinal neuroendocrine tumours. Eur J Cancer 2006;42:477-484.
  43. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M: ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415-421.
  44. Huhmann MB, August DA: Review of American Society for Parenteral and Enteral Nutrition (ASPEN) Clinical Guidelines for Nutrition Support in Cancer Patients: nutrition screening and assessment. Nutr Clin Pract 2008;23:182-188.
  45. Norman K, Pichard C, Lochs H, Pirlich M: Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27:5-15.
  46. Detsky AS, Baker JP, Mendelson RA, Wolman SL, Wesson DE, Jeejeebhoy KN: Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN J Parenter Enteral Nutr 1984;8:153-159.
  47. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z: Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-336.
  48. Frisancho AR: New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981;34:2540-2545.
    External Resources
  49. Norman K, Stobäus N, Pirlich M, Bosy-Westphal A: Bioelectrical phase angle and impedance vector analysis - clinical relevance and applicability of impedance parameters. Clin Nutr 2012;31:854-861.
  50. Gupta D, Lis CG: Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 2010;9:69.
  51. Kyle UG, Pirlich M, Schütz T, Lochs H, Pichard C: Is nutritional depletion by Nutritional Risk Index associated with increased length of hospital stay? A population-based study. JPEN J Parenter Enteral Nutr 2004;28:99-104.
  52. Amaral TF, Antunes A, Cabral S, Alves P, Kent-Smith L: An evaluation of three nutritional screening tools in a Portuguese oncology centre. J Hum Nutr Diet 2008;21:575-583.
  53. Makhija S, Baker J: The Subjective Global Assessment: a review of its use in clinical practice. Nutr Clin Pract 2008:23:405-409.
  54. Norman K, Smoliner C, Kilbert A, Valentini L, Lochs H, Pirlich M: Disease-related malnutrition but not underweight by BMI is reflected by disturbed electric tissue properties in the bioelectrical impedance vector analysis. Br J Nutr 2008;100:590-595.
  55. Orrevall Y, Tishelman C, Permert J, Cederholm T: Nutritional support and risk status among cancer patients in palliative home care services. Support Care Cancer 2009;17:153-161.
  56. Schwegler I, von Holzen A, Gutzwiller J-P, Schlumpf R, Mühlebach S, Stanga Z: Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg 2010;97:92-97.
  57. Kushner RF, Schoeller DA: Estimation of total body water by bioelectrical impedance analysis. Am J Clin Nutr 1986;44:417-424.
    External Resources
  58. Bosy-Westphal A, Danielzik S, Dörhöfer RP, Later W, Wiese S, Müller MJ: Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index. JPEN J Parenter Enteral Nutr 2006;30:309-316.
  59. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, Heitmann BL, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, Schols AMWJ, Pichard C: Bioelectrical impedance analysis - part I: review of principles and methods. Clin Nutr 2004;23:1226-1243.
  60. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, Heitmann BL, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, Schols AMWJ, Pichard C: Bioelectrical impedance analysis - part II: utilization in clinical practice. Clin Nutr 2004;23:1430-1453.
  61. Corish CA, Flood P, Kennedy NP: Comparison of nutritional risk screening tools in patients on admission to hospital. J Hum Nutr Diet 2004;17:133-139; quiz 141-143.
  62. Garcia-Carbonero R, Capdevila J, Crespo-Herrero G, Díaz-Pérez JA, Martínez Del Prado MP, Alonso Orduña V, Sevilla-García I, Villabona-Artero C, Beguiristain-Gómez A, Llanos-Muñoz M, Marazuela M, Alvarez-Escola C, Castellano D, Vilar E, Jiménez-Fonseca P, Teulé A, Sastre-Valera J, Benavent-Viñuelas M, Monleon A, Salazar R: Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE). Ann Oncol 2010;21:1794-1803.
  63. Pelzer U, Arnold D, Gövercin M, Stieler J, Doerken B, Riess H, Oettle H: Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study. BMC Cancer 2010;10:86.
  64. Gupta D, Lammersfeld CA, Vashi PG, King J, Dahlk SL, Grutsch JF, Lis CG: Bioelectrical impedance phase angle as a prognostic indicator in breast cancer. BMC Cancer 2008;8:249.
  65. Cano NJM, Aparicio M, Brunori G, Carrero JJ, Cianciaruso B, Fiaccadori E, Lindholm B, Teplan V, Fouque D, Guarnieri G, et al: ESPEN Guidelines on Parenteral Nutrition: adult renal failure. Clin Nutr 2009;28:401-414.
  66. Jensen GL, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba RF, Hardy G, Kondrup J, Labadarios D, Nyulasi I, Castillo Pineda JC, Waitzberg D: Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. Clin Nutr 2010;29:151-153.
  67. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liperda M: EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 2008;27:340-349.
  68. Gupta D, Lis CG, Dahlk SL, Vashi PG, Grutsch JF, Lammersfeld CA: Bioelectrical impedance phase angle as a prognostic indicator in advanced pancreatic cancer. Br J Nutr 2004;92:957-962.
  69. Laky B, Janda M, Kondalsamy-Chennakesavan S, Cleghorn G, Obermair A: Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study. BMC Cancer 2010;10:232-237.
  70. Norman K, Stobäus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R, Smoliner C, Pirlich M: Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr 2010;92:612-619.
  71. Yao JC, Shah MH, Ito T, Bohas CL, Wolin EM, Van Cutsem E, Hobday TJ, Okusaka T, Capdevila J, de Vries EG, Tomassetti P, Pavel ME, Hoosen S, Haas T, Lincy J, Lebwohl D, Öberg K: Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 2011;364:514-523.
  72. Pavel ME, Hainsworth JD, Baudin E, Peeters M, Hörsch D, Winkler RE, Klimovsky J, Lebwohl D, Jehl V, Wolin EM, Öberg K, Van Cutsem E, Yao JC: Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study. Lancet 2011;378:2005-2012.
  73. Raymond E, Dahan L, Raoul JL, Bang YJ, Borbath I, Lombard-Bohas C, Valle J, Metrakos P, Smith D, Vinik A, Chen JS, Hörsch D, Hammel P, Wiedenmann B, Van Cutsem E, Patyna S, Lu DR, Blanckmeister C, Chao R, Ruszniewski P: Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med 2011;364:501-553.
  74. Santoni M, Conti A, De Giorgi U, Iacovelli R, Pantano F, Burattini L, Muzzonigro G, Berardi R, Santini D, Cascinu S: Risk of gastrointestinal events with sorafenib, sunitinib and pazopanib in patients with solid tumors: a systematic review and meta-analysis of clinical trials. Int J Cancer 2014;135:763-773.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 14, 2015
Accepted: November 30, 2015
Published online: December 08, 2015
Issue release date: November 2016

Number of Print Pages: 15
Number of Figures: 6
Number of Tables: 6

ISSN: 0028-3835 (Print)
eISSN: 1423-0194 (Online)

For additional information: https://www.karger.com/NEN


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.