Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Nutrition. 2022 Jun;98:111636. doi: 10.1016/j.nut.2022.111636. Epub 2022 Feb 22.
The aim of this study was to investigate the predictive effects of skeletal muscle mass (SMM) depletion on relapse risk in patients who had undergone complete surgical resection for primary resectable gastrointestinal stromal tumors (GISTs).
This retrospective study comprised 445 enrolled patients with primary resectable GISTs who had undergone surgical treatment between January 2013 and January 2021. The lumbar skeletal muscle index (SMI) was assessed using abdominal computed tomography images taken within 7 d preoperatively. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors for nomogram construction. Predictive accuracy and discriminative ability were measured using the concordance index (C-index).
Three- and 5-y relapse-free survival (RFS) rates for patients in the low SMI group were significantly worse than those in the high SMI group (81.3 and 75.4% versus 92.3 and 91.6%, respectively; P < 0.001). In stratification analysis using modified National Institutes of Health criteria, high-risk patients with low SMI showed significantly shorter RFS (P = 0.001). Multivariate analysis indicated that tumor size, tumor location, mitotic rates, the platelet-to-lymphocyte ratio, the prognostic nutritional index, and SMM depletion were independent prognostic factors for RFS (P < 0.05). These six variables were selected for nomogram construction, which showed superior discrimination with a C-index of 0.82.
There was a significant association between preoperative SMM depletion and a high risk for relapse in patients who had undergone complete resection for primary resectable GISTs, especially in patients with high-risk GIST. Our simple, practical, novel nomogram intuitively predicted RFS in these patients.
本研究旨在探讨骨骼肌质量（SMM）耗竭对接受原发性可切除胃肠道间质瘤（GIST）完全手术切除患者复发风险的预测作用。
本回顾性研究纳入了 2013 年 1 月至 2021 年 1 月期间接受手术治疗的 445 例原发性可切除 GIST 患者。在术前 7d 内使用腹部 CT 图像评估腰椎骨骼肌指数（SMI）。采用单因素和多因素 Cox 回归分析确定列线图构建的独立危险因素。采用一致性指数（C-index）评估预测准确性和判别能力。
低 SMI 组患者的 3 年和 5 年无复发生存率（RFS）明显差于高 SMI 组（81.3%和 75.4%比 92.3%和 91.6%；P<0.001）。使用改良 NIH 标准进行分层分析，低 SMI 的高危患者 RFS 明显更短（P=0.001）。多因素分析表明，肿瘤大小、肿瘤位置、有丝分裂率、血小板与淋巴细胞比值、预后营养指数和 SMM 耗竭是 RFS 的独立预后因素（P<0.05）。这六个变量被选入列线图构建，C-index 为 0.82，具有较好的判别能力。
原发性可切除 GIST 患者完全切除术后 SMM 耗竭与复发风险高显著相关，尤其是高危 GIST 患者。我们的简单、实用、新颖的列线图直观地预测了这些患者的 RFS。
