Title: Effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes
in patients with locally advanced GIST
Version: 1 Date: 06 Jun 2022
Reviewer's report:
This study evaluated the associations between skeletal muscle and postoperative complications,
survival and tumor response in patients with locally advanced gastrointestinal stromal tumors
(LA-GIST) during neoadjuvant therapy with imatinib. Although the findings of the authors are
interesting, I have concerns regarding that the low number of events may lack statistical power
to provide useful information. In addition, there is also lack of analysis of the side effects of
imatinib and muscle change.  My specific comments are as below:
1. The number of events were overall low in pathological response (mild post-op pathological
response (n= 5)), surgical complications (Clavien-Dindo grade III (n=4)), and death (n=8). This
is a critical drawback that I have serious concerns. Multivariate analysis with these low number
of events are not convincible.
2. The information of side effects, dose modification and discontinuation, and compliances
of imatinib are important to this study. I recommend the authors to add these information
and to further analyze their associations with the SMI changes. This can provide more useful
information to potentially improve quality of care and preserve muscle in patients with LA-
GIST during imatinib.
3. The information of software used to measure skeletal muscle showed be provided.
4. In the Figure 5, the number at risk should be provided.
5. What was the duration between CT scans? The comparison of CT durations between patients
with SML and No-SML should be provided.
6. Did these patient occur early resistance to imatinib in these patients? Would patients with
early resistance have shorter duration of CT scans and the SMI change was expanded after
normalization?
Title: Effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes
in patients with locally advanced GIST
Version: 1 Date: 06 Jun 2022
Reviewer's report:
This study evaluated the associations between skeletal muscle and postoperative complications,
survival and tumor response in patients with locally advanced gastrointestinal stromal tumors
(LA-GIST) during neoadjuvant therapy with imatinib. Although the findings of the authors are
interesting, I have concerns regarding that the low number of events may lack statistical power
to provide useful information. In addition, there is also lack of analysis of the side effects of
imatinib and muscle change.  My specific comments are as below:
1. The number of events were overall low in pathological response (mild post-op pathological
response (n= 5)), surgical complications (Clavien-Dindo grade III (n=4)), and death (n=8). This
is a critical drawback that I have serious concerns. Multivariate analysis with these low number
of events are not convincible.
2. The information of side effects, dose modification and discontinuation, and compliances
of imatinib are important to this study. I recommend the authors to add these information
and to further analyze their associations with the SMI changes. This can provide more useful
information to potentially improve quality of care and preserve muscle in patients with LA-
GIST during imatinib.
3. The information of software used to measure skeletal muscle showed be provided.
4. In the Figure 5, the number at risk should be provided.
5. What was the duration between CT scans? The comparison of CT durations between patients
with SML and No-SML should be provided.
6. Did these patient occur early resistance to imatinib in these patients? Would patients with
early resistance have shorter duration of CT scans and the SMI change was expanded after
normalization?
Please review this paper.
user
Title: Effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes
in patients with locally advanced GIST
Version: 1 Date: 06 Jun 2022
Reviewer's report:
This study evaluated the associations between skeletal muscle and postoperative complications,
survival and tumor response in patients with locally advanced gastrointestinal stromal tumors
(LA-GIST) during neoadjuvant therapy with imatinib. Although the findings of the authors are
interesting, I have concerns regarding that the low number of events may lack statistical power
to provide useful information. In addition, there is also lack of analysis of the side effects of
imatinib and muscle change.  My specific comments are as below:
1. The number of events were overall low in pathological response (mild post-op pathological
response (n= 5)), surgical complications (Clavien-Dindo grade III (n=4)), and death (n=8). This
is a critical drawback that I have serious concerns. Multivariate analysis with these low number
of events are not convincible.
2. The information of side effects, dose modification and discontinuation, and compliances
of imatinib are important to this study. I recommend the authors to add these information
and to further analyze their associations with the SMI changes. This can provide more useful
information to potentially improve quality of care and preserve muscle in patients with LA-
GIST during imatinib.
3. The information of software used to measure skeletal muscle showed be provided.
4. In the Figure 5, the number at risk should be provided.
5. What was the duration between CT scans? The comparison of CT durations between patients
with SML and No-SML should be provided.
6. Did these patient occur early resistance to imatinib in these patients? Would patients with
early resistance have shorter duration of CT scans and the SMI change was expanded after
normalization?
assistant