Correlation between sarcopenia and esophageal stenosis following endoscopic submucosal dissection and construction of a postoperative stenosis risk model

Table 1 Patient characteristics, n (%)/median (interquartile range)

Characteristics	Non-sarcopenia (n = 358)	Sarcopenia (n = 141)	P value
Age, years	66.0 (61.0, 70.8)	69.0 (64.0, 74.0)	< 0.001
Male	286 (79.89)	71 (50.35)	< 0.001
Height, cm	168.0 (160.0, 170.00)	165.0 (160.0, 170.0)	0.024
Weight, kg	65.0 (58.0, 73.0)	56.0 (51.0, 63.0)	< 0.001
BMI, kg/m2	23.7 (21.9, 25.8)	20.9 (19.4, 22.7)	< 0.001
Chronic conditions
Hypertension	131 (36.59)	42 (29.79)	0.15
Type 2 diabetes	25 (6.98)	9 (6.38)	0.811
Smoking history	84 (23.46)	25 (17.73)	0.163
Drinking history	62 (17.32)	16 (11.35)	0.098
Surgical history	36 (10.06)	18 (12.77)	0.380
Hospitalization duration	9.0 (7.0, 11.0)	9.0 (8.0, 12.0)	0.009
Procedure time			0.026
< 120 minutes	300 (83.8)	106 (75.2)
≥ 120 minutes	58 (16.2)	35 (24.8)
Prevention of stenosis
Intraoperative	18 (5.03)	17 (12.06)	0.006
Postoperative	39 (10.89)	13 (9.22)	0.582
Wound management	314 (87.71)	122 (86.52)	0.720
Malnutrition
CONUT ≥ 2	131 (36.59)	64 (45.39)	0.07
PNI < 50	188 (52.51)	85 (60.28)	0.116
WBC	5.34 (4.46, 6.40)	5.31 (4.56, 6.62)	0.395
HGB, g/L	139.0 (129.3, 149.0)	131.0 (120.0, 141.0)	< 0.001
NLR	2.38 (1.80, 3.35)	2.68 (1.93, 3.92)	0.038
ALB, mean ± SD	42.48 ± 4.11	41.57 ± 4.06	0.026
L3-SMI	48.85 (44.62, 52.69)	36.85 (33.30, 38.99)	< 0.001
SMA	135.1 (122.32, 150.52)	95.40 (87.22, 110.10)	< 0.001
VATA	115.55 (54.31, 162.12)	67.72 (29.63, 116.60)	< 0.001
IMAT	5.04 (2.83, 8.11)	5.07 (3.04, 9.24)	0.416
SATA	108.60 (71.91, 137.90)	95.22 (59.85, 134.00)	0.027
Visceral obesity	205 (57.26)	48 (34.04)	< 0.001

Intraoperative: Intraoperative hormone use for stenosis prevention; Postoperative: Postoperative oral hormone use for stenosis prevention; BMI: Body mass index; CONUT: Controlling Nutritional Status score; PNI: Prognostic Nutritional Index; NLR: Neutrophil-to-lymphocyte ratio; WBC: White blood cell count; HGB: Hemoglobin concentration; ALB: Serum albumin concentration; L3-SMI: Third lumbar vertebra skeletal muscle index; SMA: Skeletal muscle area; VATA: Visceral adipose tissue area; IMAT: Intermuscular adipose tissue; SATA: Subcutaneous adipose tissue area.

Table 2 Characterization of lesions and postoperative pathological features, n (%)

Characteristics	Non-sarcopenia (n = 358)	Sarcopenia (n = 141)	P value
Histological classification			0.427
HGA	136 (37.99)	59 (41.84)
ESCC	212 (62.01)	82 (58.15)
Lesion morphology			0.708
II a	53 (14.80)	18 (12.77)
II b	237 (66.20)	93 (65.96)
II c	7 (1.96)	5 (3.55)
Combined	61 (17.04)	25 (17.73)
Location			0.023
Upper	60 (16.76)	41 (29.08)
Middle	109 (30.45)	37 (26.24)
Lower	184 (51.40)	62 (43.97)
Entire	5 (1.40)	1 (0.71)
Circumferential range			< 0.001
< 3/4	295 (82.40)	95 (67.38)
≥ 3/4	63 (17.60)	46 (32.62)
Lesion length, mm, M (IQR)	37.0 (30.0, 50.0)	45.0 (34.0, 53.0)	0.004
Muscular injury	41 (11.5)	25 (17.73)	0.062
Depth			0.447
M1	293 (81.84)	115 (81.56)
M2	42 (11.73)	12 (8.51)
M3	16 (4.47)	10 (7.09)
SM1	7 (1.96)	4 (2.84)
R0 resection	350 (97.77)	137 (97.16)	0.943

M: Median; IQR: Interquartile range; HGA: High-grade intraepithelial neoplasia; ESCC: Esophageal squamous cell carcinoma; Combined: Comprising two or more lesion morphologies; II a: Superficial elevated type; II b: Superficial flat type; II c: Superficial depressed type; M1: Mucosal epithelial layer; M2: Lamina propria of mucosa; M3: Muscularis mucosae; SM1: Invasion of submucosa with a distance from the mucosal layer ≤ 200 μm.

Table 3 Postoperative complications and follow-up, n (%)

	Non-sarcopenia (n = 358)	Sarcopenia (n = 141)	P value
Complications
Delayed bleeding	12 (3.35)	4 (2.84)	0.991
Delayed perforation	7 (1.96)	2 (1.42)	0.974
Stenosis	80 (22.35)	68 (48.23)	< 0.001
Others	13 (3.63)	5 (3.55)	0.963
Adverse events	175 (48.89)	88 (62.41)	0.006
Additional endoscopic treatment	67 (18.72)	57 (40.43)	< 0.001

Adverse events: Proportion of patients with adverse events.

Table 4 Analysis of body composition indices and stenosis, median (interquartile range)

Body composition indices	Non-stenosis (n = 351)	Stenosis (n = 148)	P value
L3-SMI	46.24 (41.17, 51.25)	42.00 (37.51, 49.16)	< 0.001
SMA	130.50 (110.45, 146.30)	116.85 (92.69, 135.17)	< 0.001
VATA	101.90 (47.47, 150.40)	98.63 (52.46, 142.50)	0.73
IMAT	5.19 (2.68, 8.28)	4.94 (3.17, 9.26)	0.639
SATA	106.10 (67.06, 136.25)	110.00 (74.99, 142.77)	0.356

L3-SMI: Third lumbar vertebra skeletal muscle index; SMA: Skeletal muscle area; VATA: Visceral adipose tissue area; IMAT: Intermuscular adipose tissue; SATA: Subcutaneous adipose tissue area.

Table 5 Univariate and multivariate analyses of risk factors for stenosis

Variables	Univariate analysis		Multivariate analysis
	P value	OR (95%CI)	P value	OR (95%CI)
Sarcopenia	< 0.001	3.24 (2.14-4.89)	< 0.001	3.86 (1.76-8.45)
Male	< 0.001	0.39 (0.26-0.59)
Lesion length ≥ 45 mm	< 0.001	5.03 (3.33-7.62)	0.031	1.84 (1.06-3.21)
Histological classification
HGA		1.00 (reference)
ESCC	< 0.001	2.46 (1.60-3.77)
Depth
M1		1.00 (reference)
M2	0.064	1.75 (0.97-3.15)
M3	0.013	2.74 (1.23-6.10)
SM1	0.179	2.29 (0.68-7.64)
Location
Upper		1.00 (reference)
Middle	0.012	0.50 (0.29-0.86)
Lower	0.015	0.55 (0.34-0.89)
Entire	0.651	1.46 (0.28-7.61)
Procedure time ≥ 120 minutes	< 0.001	3.65 (2.29-5.83)	0.060	1.83 (0.98-3.42)
Muscular injury	< 0.001	5.00 (2.90-8.60)	< 0.001	4.47 (2.20-9.08)
Circumferential range ≥ 3/4	< 0.001	13.06 (7.93-21.51)	< 0.001	7.60 (3.96-14.59)
Lesion morphology
II a		1.00 (reference)
II b	0.287	1.39 (0.76-2.55)
II c	0.282	0.31 (0.04-2.61)
Combined	0.011	2.47 (1.23-5.00)
PNI < 50	0.049	1.48 (1.01-2.19)
Weight	0.032	0.98 (0.96-0.99)
Height	0.031	0.97 (0.95-0.99)
Hospitalization duration	0.010	1.06 (1.01-1.11)
HGB	0.045	0.99 (0.98-0.99)

OR: Odds ratio; CI: Confidence interval; HGA: High-grade intraepithelial neoplasia; ESCC: Esophageal squamous cell carcinoma; Combined: Comprising two or more lesion morphologies; II a: Superficial elevated type; II b: Superficial flat type; II c: Superficial depressed type; M1: Mucosal epithelial layer; M2: Lamina propria of mucosa; M3: Muscularis mucosae; SM1: Invasion of submucosa with a distance from the mucosal layer ≤ 200 μm; PNI: Prognostic Nutritional Index; HGB: Hemoglobin concentration.

Table 6 Univariate and multivariate logistic regression analyses after propensity score matching

Caliper value	Variables	Univariate analysis		Multivariate analysis
		P value	OR (95%CI)	P value	OR (95%CI)
0.2 SD	Sarcopenia	0.012	2.26 (1.21-4.32)	0.003	3.65 (1.61-8.76)
0.1 SD		0.012	2.41 (1.22-4.83)	0.004	3.69 (1.55-9.41)

OR: Odds ratio; CI: Confidence interval; 0.1 SD: 0.1 times the SD of the propensity score; 0.2 SD: 0.2 times the SD of the propensity score.

Table 7 Variables selected from the training set data for constructing the risk prediction model

Variable	OR	95%CI	P value
Sarcopenia			< 0.001
No	-	-
Yes	2.89	1.55-5.41
Lesion length			0.008
< 45 mm	-	-
≥ 45 mm	2.37	1.25-4.47
Muscular injury			< 0.001
No	-	-
Yes	4.97	2.32-10.90
Circumferential range			< 0.001
< 3/4	-	-
≥ 3/4	6.84	3.50-13.70
Procedure time			0.013
< 120 minutes	-	-
≥ 120 minutes	2.42	1.21-4.88

OR: Odds ratio; CI: Confidence interval.