Skeletal Muscle Volume by 3D Imaging and Long-term Survival in Esophageal Squamous Cell Carcinoma with Neoadjuvant Chemotherapy

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 mass index (SMI), assessed by 3D imaging, on survival outcomes. Methods We retrospectively reviewed 139 consecutive ESCC patients who underwent surgical resection following NAC. SMI was measured pre-NAC and post- NAC using 3D imaging, and post-NAC SMI was stratified into quartiles (Q1-Q4). We evaluated overall survival (OS) and relapse-free survival (RFS) in relation to these quartiles. Results Q1 (lowest SMI) group was significantly correlated with postoperative pneumonia (p = 0.03) and had poorer 3-year OS and RFS compared with Q2-Q4 group (P < 0.01). Multivariate analysis identified Q1 as an independent predictor of poor OS (hazard ratio, 3.22; 95%Confidence Interval, 1.86–5.57; P < 0.01). Conclusions Low SMI after NAC assessed by 3D imaging is an independent predictor of poor overall and relapse-free survival in patients undergoing radical resection for ESCC. These findings underscore the importance of maintaining SMI in 3D imaging after NAC.