The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.
Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China.
BMC Gastroenterol. 2022 Aug 26;22(1):399. doi: 10.1186/s12876-022-02479-4.
Currently, the effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes in patients with locally advanced gastrointestinal stromal tumors (LA-GIST) remains unclear. This study aims to investigate the relationship between changes in skeletal muscle and postoperative complications, survival and tumor response in patients with LA-GIST during neoadjuvant therapy with imatinib.
We retrospectively analyzed pre- and post-treatment computed tomography images of 57 GIST patients who underwent radical surgery after neoadjuvant therapy with imatinib from January 2013 to March 2019. Skeletal muscle index (SMI) was measured at the L3 vertebral level in all patients. A cut-off value (SMI < 52.3 cm/m and < 38.6 cm/m for men and women, respectively) published in a previous study was used to define sarcopenia. Based on gender, we defined ΔSMI (%)/250 days above 9.69% for men and ΔSMI (%)/250 days above 7.63% for women as significant muscle loss (SML). Factors associated with postoperative complications and tumor response were analyzed using logistic regression, and predictors affecting patient prognosis were analyzed using Cox regression.
Of the 57 patients, sarcopenia was present before and after neoadjuvant therapy in 20 (35.09%) and 28 (49.12%) patients, respectively. It was not associated with immediate or long-term clinical outcomes. However, patients with SML during neoadjuvant therapy had a higher incidence of postoperative complications (60.00% vs. 25.00%, p = 0.008), worse pathological regression (44.00% vs. 75.00%, p = 0.017) and worse 3-year survival (Male, 68.75% vs. 95.45%, p = 0.027; Female, 66.67% vs. 100.00%, p = 0.046) than patients without SML.
The development of SML during neoadjuvant therapy in LA-GIST patients, rather than pre- and post-treatment sarcopenia, is a major prognostic factor for the long-term prognosis and is also associated with recent postoperative complication rates and pathological regression.
目前，新辅助伊马替尼治疗期间骨骼肌丢失对局部晚期胃肠间质瘤（LA-GIST）患者的临床结局的影响尚不清楚。本研究旨在探讨新辅助伊马替尼治疗期间骨骼肌变化与 LA-GIST 患者术后并发症、生存和肿瘤反应的关系。
我们回顾性分析了 2013 年 1 月至 2019 年 3 月期间接受新辅助伊马替尼治疗后行根治性手术的 57 例 GIST 患者的治疗前和治疗后计算机断层扫描图像。所有患者均在 L3 椎体水平测量骨骼肌指数（SMI）。使用之前发表的一项研究中定义的截值（男性 SMI<52.3 cm/m 和女性 SMI<38.6 cm/m）来定义肌肉减少症。根据性别，我们定义男性 SMI 增加>9.69%/250 天和女性 SMI 增加>7.63%/250 天为显著肌肉减少（SML）。使用逻辑回归分析与术后并发症和肿瘤反应相关的因素，并使用 Cox 回归分析影响患者预后的预测因素。
在 57 例患者中，20 例（35.09%）和 28 例（49.12%）患者在新辅助治疗前后分别存在肌肉减少症。它与即刻或长期临床结局无关。然而，在新辅助治疗期间发生 SML 的患者术后并发症发生率更高（60.00% vs. 25.00%，p=0.008），病理缓解更差（44.00% vs. 75.00%，p=0.017），3 年生存率更差（男性，68.75% vs. 95.45%，p=0.027；女性，66.67% vs. 100.00%，p=0.046）。
LA-GIST 患者新辅助治疗期间 SML 的发展，而不是治疗前后的肌肉减少症，是长期预后的一个主要预后因素，并且与近期术后并发症发生率和病理缓解相关。
