Significant muscle loss during neoadjuvant therapy with imatinib may be associated with postsurgical complications and a worse prognosis in patients with gastrointestinal stromal tumor (GIST).
According to a study published in BMC Gastroenterology, GIST patients with significant muscle loss had a significantly higher rate of postoperative complications than those who did not have significant muscle loss (60% vs 25%; P =.008). Significant muscle loss was defined as a change in skeletal muscle index per 250 days of more than 9.69% for men and 7.63% for women.
Most complications were Clavien-Dindo grade 1 or 2. Some Clavien-Dindo grade 3 complications were observed in the significant muscle loss group, however, the difference between the 2 groups was not significant (16% vs 0%; P =.257).
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Subgroup analysis based on biological sex showed that 3-year survival rates were significantly lower in patients with significant muscle loss than in those without significant muscle loss for both male (68.75% vs 95.45%; P =.027) and female patients (66.67% vs 100.00%; P =.046).
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No significant differences in 3-year survival were observed between patients with pretreatment sarcopenia and those without sarcopenia (P =.827) or between patients with post-treatment sarcopenia and those without sarcopenia (P =.906).
Several risk factors affecting 3-year survival were also uncovered using univariate Cox regression analysis, including tumor diameter, mitotic index, baseline albumin levels, significant muscle loss during neoadjuvant therapy, and whether imatinib therapy is continued postoperatively.
On the multivariate analysis, significant muscle loss during neoadjuvant therapy (hazard ratio [HR], 6.922; 95% CI, 2.892–16.091) and postoperative imatinib therapy (HR, 0.018; 95% CI, 0.005–0.376) were both independent risk factors.
A total of 57 patients with locally advanced GIST were included in the study. Sarcopenia was already present in 20 patients prior to imatinib therapy, and 28 patients had sarcopenia after therapy. Of these patients, 25 were categorized as having significant muscle loss based on the previously mentioned cutoff values.
All patients underwent radical resection surgery, and 23 cases developed postoperative complications. During follow-up, which ranged from 19.2 to 64.2 months, there were 8 deaths, and the overall 3-year survival rate was 85.96%.
Reference
Ding P, Guo H, He X, et al. Effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes in patients with locally advanced GIST. BMC Gastroenterol. 2022;22(1):399. doi:10.1186/s12876-022-02479-4
