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. 2022 Sep 2:9:963265.
doi: 10.3389/fnut.2022.963265. eCollection 2022.

Serum creatinine/cystatin C ratio is a systemic marker of sarcopenia in patients with gastrointestinal stromal tumours

Ping'an Ding  1   2 , Honghai Guo  1   2 , Chenyu Sun  3 , Shuya Chen  4 , Peigang Yang  1   2 , Yuan Tian  1   2 , Scott Lowe  5 , Qun Zhao  1   2
Affiliations

Serum creatinine/cystatin C ratio is a systemic marker of sarcopenia in patients with gastrointestinal stromal tumours

Ping'an Ding et al. Front Nutr. .

Abstract

Background: It is well known that sarcopenia is a common risk factor in patients with gastrointestinal tumours, which may negatively affect the clinical outcome and prognosis. Recent studies suggest that serum creatinine-cystatin C (Cr/CysC) ratio may be associated with sarcopenia, but this association lacks sufficient evidence in patients with gastrointestinal stromal tumours (GIST). Therefore, this study aimed to investigate whether the Cr/CysC ratio was associated with sarcopenia and recurrence-free survival (RFS) in patients with GIST.

Materials and methods: The study retrospectively analysed 413 patients with GIST who underwent surgical resection from January 2016 to January 2020. The serum Cr/CysC ratio was determined as a proxy for sarcopenia by comparing it with various biomarkers and Cox multifactorial analysis was used to determine the relationship between Cr/CysC ratio and prognosis.

Results: Serum Cr/CysC was positively correlated with skeletal muscle area (SMA) (r = 0.256, p < 0.001), skeletal muscle index (SMI) (r = 0.300, p < 0.001), and hand grip strength (HGS) (r = 0.251, p < 0.001). The area under the receiver operator characteristic curve for sarcopenic subjects with serum Cr/CysC ratio was significantly greater than other biomarkers (Cr/CysC: 0.840, CysC: 0.732, Cr: 0.518). The optimal cut-off value for Cr/CysC was 0.65, and patients in the high Cr/CysC group had a higher 3-year recurrence-free survival (RFS) than those in the low Cr/CysC group (92.72 vs. 72.46%, p < 0.001). Cox multifactorial analysis found that the Cr/CysC ratio was an independent risk factor for RFS in GIST patients (HR = 2.143, 95% CI: 1.431-5.459, p = 0.011).

Conclusion: Serum Cr/CysC ratio has satisfactory and comparable diagnostic accuracy, and prognostic value for sarcopenia in patients with GIST. Therefore, it can be a simple and practical clinical tool to screen sarcopenia in GIST patients. However, further studies are required to validate these findings.

Keywords: gastrointestinal stromal tumors; sarcopenia; serum Cr/CysC ratio; serum creatinine; serum cystatin C.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Receiver operator characteristic curves for the analysis of serum Cr/CysC ratio, CysC and Cr levels for the diagnosis of sarcopenia according to gender. (A), All patients; (B), Male patients; (C), Female patients.
FIGURE 2
FIGURE 2
Comparison of the prognosis of patients with low and high serum creatine (Cr)/cystatin C (CysC) ratios. (A), All patients; (B), Male patients; (C), Female patients. Cr/CysC < 0.65 was defined as low Cr/CysC; Cr/CysC > 0.65 was defined as high Cr/CysC.
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