Impact of skeletal muscle loss and sarcopenia on outcomes of neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma.

IF 4 2区农林科学 Q2 NUTRITION & DIETETICS

Frontiers in Nutrition Pub Date : 2025-09-12 eCollection Date: 2025-01-01 DOI:10.3389/fnut.2025.1650337

Binwen Xu, Junhong Liu, Yue Zhang, Tao Luo, Jie Xiong, Hanxiao Wang, Guidong Shi, Maoyong Fu

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Abstract

Background: 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.

Methods: 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 cm²/m² in men and <38.5 cm²/m² in women, and a ΔSMI% < -2.8% was designated as excessive skeletal muscle loss.

Results: The prevalence of sarcopenia increased from 50.9% before treatment to 55.1% at therapy completion. Pre-NICT sarcopenia correlated with tumor progression (p = 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%, p = 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, p = 0.04). In a subgroup analysis of excessive skeletal muscle loss, these patients experienced higher hematologic toxicity (leukopenia: 33.4% vs. 20.9%, p = 0.04; anemia: 70.7% vs. 50.6%, p = 0.01) and lower pCR rate (12.0% vs. 22.8%, p = 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) (p > 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; p = 0.03); however, it was not associated with DFS (p = 0.22).

Conclusion: 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.

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骨骼肌损失和肌肉减少对食管鳞状细胞癌新辅助免疫化疗结果的影响。

背景：骨骼肌减少症是一种以骨骼肌质量和功能的进行性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。我们旨在评估局部晚期ESCC患者治疗期间骨骼肌减少和骨骼肌动态变化对新辅助免疫化疗（NICT）疗效和预后的影响。方法：我们回顾性纳入272例接受NICT治疗的局部晚期ESCC患者。我们计算了骨骼肌指数（SMI）及其变化率（ΔSMI%）从治疗前后获得的L3椎体水平的CT图像。肌少症的定义为男性和女性的SMI分别为 2/m2和ΔSMI% 。结果：肌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前肌少症与肿瘤进展相关（p = 0.02），且肌少症患者的病理完全缓解（pCR）明显低于无肌少症患者（14.7% vs. 25.0%, p = 0.04）。肿瘤进展患者的SMI明显低于疾病对照组（41.6 ± 7.24 vs. 48.71 ± 8.39,p = 0.04）。在过度骨骼肌损失的亚组分析中，这些患者有较高的血液学毒性（白细胞减少：33.4% vs. 20.9%, p = 0.04；贫血：70.7% vs. 50.6%, p = 0.01）和较低的pCR率（12.0% vs. 22.8%, p = 0.05）。中位随访20.4 个月后，NICT前后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，治疗期间过度的骨骼肌损失成为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）。结论：治疗引起的过度骨骼肌损失可能是局部晚期ESCC患者NICT毒性和短期生存的预测指标，强调需要动态营养监测以优化治疗耐受性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Nutrition Agricultural and Biological Sciences-Food Science

CiteScore

5.20

自引率

8.00%

发文量

2891

审稿时长

12 weeks

期刊介绍： No subject pertains more to human life than nutrition. The aim of Frontiers in Nutrition is to integrate major scientific disciplines in this vast field in order to address the most relevant and pertinent questions and developments. Our ambition is to create an integrated podium based on original research, clinical trials, and contemporary reviews to build a reputable knowledge forum in the domains of human health, dietary behaviors, agronomy & 21st century food science. Through the recognized open-access Frontiers platform we welcome manuscripts to our dedicated sections relating to different areas in the field of nutrition with a focus on human health. Specialty sections in Frontiers in Nutrition include, for example, Clinical Nutrition, Nutrition & Sustainable Diets, Nutrition and Food Science Technology, Nutrition Methodology, Sport & Exercise Nutrition, Food Chemistry, and Nutritional Immunology. Based on the publication of rigorous scientific research, we thrive to achieve a visible impact on the global nutrition agenda addressing the grand challenges of our time, including obesity, malnutrition, hunger, food waste, sustainability and consumer health.