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ORIGINAL RESEARCH article

Front. Nutr.

Sec. Clinical Nutrition

Volume 12 - 2025 | doi: 10.3389/fnut.2025.1650337

This article is part of the Research TopicThe Role of Nutrition in Enhancing Surgical Recovery and OutcomesView all 4 articles

Impact of Skeletal Muscle Loss and Sarcopenia on Outcomes of neoadjuvant immunochemotherapy in Esophageal Squamous Cell Carcinoma

Provisionally accepted
Binwen  XuBinwen Xu*Junhong  LiuJunhong LiuYue  ZhangYue ZhangTao  LuoTao LuoJie  XiongJie XiongHanxiao  WangHanxiao WangGuidong  ShiGuidong ShiMaoyong  FuMaoyong Fu*
  • Affiliated Hospital of North Sichuan Medical College, Nanchong, China

The final, formatted version of the article will be published soon.

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.

Keywords: Sarcopenia, Skeletal muscle index, esophageal squamous cell carcinoma, Neoadjuvant immunochemotherapy, overall survival

Received: 19 Jun 2025; Accepted: 11 Aug 2025.

Copyright: © 2025 Xu, Liu, Zhang, Luo, Xiong, Wang, Shi and Fu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Binwen Xu, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
Maoyong Fu, Affiliated Hospital of North Sichuan Medical College, Nanchong, China

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