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Background <p>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.</p> Methods <p>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.</p> Results <p>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 (<i>P</i> &lt; 0.01). Multivariate analysis identified low SMI as an independent predictor of poor OS (HR: 3.22; 95% CI: 1.86–5.57; <i>P</i> &lt; 0.01).</p> Conclusions <p>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.</p>

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Skeletal muscle volume by 3D imaging and long-term survival in esophageal squamous cell carcinoma with neoadjuvant chemotherapy

  • 期刊论文

  • 发表日期：

    2025年9月22日

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  • Yuto Maeda,
  • Keisuke Kosumi,
  • Hiroki Tsubakihara,
  • Yoshihiro Hara,
  • Kojiro Eto,
  • Satoshi Ida,
  • Yuji Miyamoto,
  • Naoya Yoshida,
  • Masaaki Iwatsuki

摘要

Background

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.

Methods

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.

Results

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).

Conclusions

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.