Xu Binwen, Liu Junhong, Zhang Yue, Luo Tao, Xiong Jie, Wang Hanxiao, Shi Guidong, Fu Maoyong
Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
Front Nutr. 2025 Sep 12;12:1650337. doi: 10.3389/fnut.2025.1650337. eCollection 2025.
Sarcopenia is a systemic disorder characterized by the progressive loss of skeletal muscle mass and function; however, its impact on the treatment outcomes of patients with esophageal cancer remains inconclusive. We aimed to evaluate the impact of sarcopenia and dynamic changes in skeletal muscle during treatment on neoadjuvant immunochemotherapy (NICT) efficacy and prognosis in patients with locally advanced ESCC.
We retrospectively included 272 patients with locally advanced ESCC who received NICT. We calculated the skeletal muscle index (SMI) and its rate of change (ΔSMI%) from CT images at the L3 vertebral level obtained before and after treatment. Sarcopenia was defined as an SMI < 52.4 cm/m in men and <38.5 cm/m in women, and a ΔSMI% < -2.8% was designated as excessive skeletal muscle loss.
The prevalence of sarcopenia increased from 50.9% before treatment to 55.1% at therapy completion. Pre-NICT sarcopenia correlated with tumor progression ( = 0.02) and was associated with a significantly lower pathological complete response (pCR) in patients who had sarcopenia than in those without (14.7% vs. 25.0%, = 0.04). Patients with tumor progression had a significantly lower SMI than those in the disease-control group (41.6 ± 7.24 vs. 48.71 ± 8.39, = 0.04). In a subgroup analysis of excessive skeletal muscle loss, these patients experienced higher hematologic toxicity (leukopenia: 33.4% vs. 20.9%, = 0.04; anemia: 70.7% vs. 50.6%, = 0.01) and lower pCR rate (12.0% vs. 22.8%, = 0.05). After a median follow-up of 20.4 months, sarcopenia before or after NICT did not significantly affect overall survival (OS) or disease-free survival (DFS) ( > 0.05). Conversely, excessive skeletal muscle loss during treatment emerged as an independent prognostic factor for OS in multivariate analysis (HR = 0.47; 95% CI, 0.25-0.91; = 0.03); however, it was not associated with DFS ( = 0.22).
Treatment-induced excessive skeletal muscle loss may serve as a predictive marker for NICT toxicity and short-term survival in patients with locally advanced ESCC, highlighting the need for dynamic nutritional monitoring to optimize treatment tolerance.
肌肉减少症是一种以骨骼肌质量和功能逐渐丧失为特征的全身性疾病；然而，其对食管癌患者治疗结果的影响尚无定论。我们旨在评估肌肉减少症以及治疗期间骨骼肌的动态变化对局部晚期食管鳞状细胞癌（ESCC）患者新辅助免疫化疗（NICT）疗效和预后的影响。
我们回顾性纳入了272例接受NICT的局部晚期ESCC患者。我们根据治疗前后在L3椎体水平获得的CT图像计算骨骼肌指数（SMI）及其变化率（ΔSMI%）。肌肉减少症的定义为男性SMI < 52.4 cm/m²，女性< 38.5 cm/m²，ΔSMI% < -2.8%被指定为骨骼肌过度丢失。
肌肉减少症的患病率从治疗前的50.9%增加到治疗结束时的55.1%。NICT前的肌肉减少症与肿瘤进展相关（P = 0.02），并且与有肌肉减少症的患者相比，无肌肉减少症的患者病理完全缓解（pCR）率显著更低（14.7%对25.0%，P = 0.04）。肿瘤进展的患者SMI显著低于疾病对照组（41.6 ± 7.24对48.71 ± 8.39，P = 0.04）。在骨骼肌过度丢失的亚组分析中，这些患者经历了更高的血液学毒性（白细胞减少：33.4%对20.9%，P = 0.04；贫血：70.7%对50.6%，P = 0.01）和更低的pCR率（12.0%对22.8%，P = 0.05）。中位随访20.4个月后，NICT前后的肌肉减少症对总生存期（OS）或无病生存期（DFS）没有显著影响（P > 0.05）。相反，在多变量分析中，治疗期间骨骼肌过度丢失成为OS的独立预后因素（HR = 0.47；95%CI，0.25 - 0.91；P = 0.03）；然而，它与DFS无关（P = 0.22）。
治疗引起的骨骼肌过度丢失可能作为局部晚期ESCC患者NICT毒性和短期生存的预测标志物，突出了动态营养监测以优化治疗耐受性的必要性。
