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Impact of Skeletal Muscle Loss and Sarcopenia on Outcomes of Locally Advanced Esophageal Cancer during Neoadjuvant Chemoradiation

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript



The impact of changes in skeletal muscle and sarcopenia on outcomes during neoadjuvant chemoradiotherapy (NACR) for patients with esophageal cancer remains controversial.

Patients and Methods

We retrospectively analyzed the data of patients with locally advanced esophageal squamous cell cancer who received NACR followed by esophagectomy between June 2013 and December 2021. The images at third lumbar vertebra were analyzed to measure the cross-sectional area and calculate skeletal muscle index (SMI) before and after NACR. SMI less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women were defined as sarcopenia. The nonlinearity of the effect of percent changes in SMI (ΔSMI%) to survival outcomes was assessed by restricted cubic splines.


Overall, data of 367 patients were analyzed. The survival outcomes between sarcopenia and non-sarcopenia groups had no significant differences before NACR. However, patients in post-NACR sarcopenia group showed poor overall survival (OS) benefit (P = 0.016) and poor disease-free survival (DFS) (P = 0.043). Severe postoperative complication rates were 11.9% in post-NACR sarcopenia group and 5.0% in post-NACR non-sarcopenia group (P = 0.019). There was a significant non-linear relationship between ΔSMI% and survival outcomes (P < 0.05 for non-linear). On the multivariable analysis of OS, ΔSMI% > 12% was the independent prognostic factor (HR 1.76, 95% CI 1.03–2.99, P = 0.039) and significant difference was also found on DFS analysis (P = 0.025).


Patients with post-neoadjuvant chemoradiotherapy sarcopenia have worse survival and adverse short-term outcomes. Moreover, greater loss in SMI is associated with increased risks of death and disease progression during neoadjuvant chemoradiotherapy, with maximum impact noted with SMI loss greater than 12%.

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This work was supported by the National Natural Science Foundation of China (grant no. 81970481), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (grant nos. 2020HXFH047 and 20HXJS005), and Sichuan Science and Technology Program (grant no. 2022YFS0048).

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Correspondence to Yong Yuan MD, PhD.

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The Institutional Review Board (IRB) of West China hospital approved our study (IRB no. 2022-853), and the writing of informed consent was waived.

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Fig. S1

Flow chart of the study. Fig. S2 Correlation between change in skeletal muscle index (SMI) and weight. Fig. S3 Mean values of Δweight and ΔSMI across four groups. Fig. S4 Distribution of patients with increased or declined SMI in the sarcopenia and non-sarcopenia groups before neoadjuvant therapy (DOCX 47 KB)

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Xiao, X., Fang, PH., Zhou, JF. et al. Impact of Skeletal Muscle Loss and Sarcopenia on Outcomes of Locally Advanced Esophageal Cancer during Neoadjuvant Chemoradiation. Ann Surg Oncol 31, 3819–3829 (2024).

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