Maeda Yuto, Kosumi Keisuke, Tsubakihara Hiroki, Hara Yoshihiro, Eto Kojiro, Ida Satoshi, Miyamoto Yuji, Yoshida Naoya, Iwatsuki Masaaki
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Gen Thorac Cardiovasc Surg. 2025 Sep 22. doi: 10.1007/s11748-025-02201-7.
Neoadjuvant chemotherapy (NAC) is commonly administered to improve long-term survival in patients with locally advanced esophageal squamous cell carcinoma (ESCC). This study investigated the impact of perioperative skeletal muscle index (SMI), assessed by 3D imaging, on survival outcomes.
We retrospectively reviewed 139 ESCC patients who underwent surgical resection following NAC. SMI was measured pre- and post-NAC using 3D imaging. Patients were stratified into quartiles based on post-NAC SMI, and survival outcomes were evaluated.
Patients in the lowest SMI quartile (Q1) were more likely to develop postoperative pneumonia and had significantly worse 3-year overall survival (OS) and relapse-free survival (RFS) compared with those in Q2-Q4 (P < 0.01). Multivariate analysis identified low SMI as an independent predictor of poor OS (HR: 3.22; 95% CI: 1.86-5.57; P < 0.01).
Low SMI after NAC, as assessed by 3D imaging, is an independent predictor of poor survival in ESCC patients. These findings highlight the importance of muscle preservation and precise 3D evaluation before surgery.
