Prognostic impact of post-chemoradiotherapy muscle quality in non-elderly adults with esophageal squamous cell carcinoma

doi:10.4251/wjgo.123400

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Nov 15, 2026; 18(11): 123400
Published online Nov 15, 2026. doi: 10.4251/wjgo.123400

Prognostic impact of post-chemoradiotherapy muscle quality in non-elderly adults with esophageal squamous cell carcinoma

Ling Xiao, Yu-Hang Yang, Shi-Chuan Zhang, Jia-Hua Lyu

Ling Xiao, Yu-Hang Yang, Shi-Chuan Zhang, Jia-Hua Lyu, Department of Radiation, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China,Chengdu, China

Co-first authors: Ling Xiao and Yu-Hang Yang.

Co-corresponding authors: Shi-Chuan Zhang and Jia-Hua Lyu.

Author contributions: Xiao L handled conceptualization, project administration, resources, and supervision; Xiao L and Yang YH managed data curation, oversaw software, and visualization, and they contributed equally to this article as co-first authors; Xiao L, Yang YH, and Zhang SC took charge of methodology; Lyu JH handled funding acquisition; Xiao L, Yang YH, Zhang SC, and Lyu JH contributed to investigation, validation, writing original draft, and writing review and editing; Zhang SC and Lyu JH contributed equally to this article as co-corresponding authors; and all authors thoroughly reviewed and endorsed the final manuscript.

AI contribution statement: Gemini 3 was used only for language polishing and improving academic English readability. It was not involved in study design, data analysis, result interpretation or conclusion generation. All scientific content was independently completed by the authors based on original clinical data.

Institutional review board statement: This study was approved by the Ethics Committee of Sichuan Cancer Hospital (Approval No. SCCHEC2015010).

Informed consent statement: The informed consent was waived by the Institutional Review Board.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.

Corresponding author: Jia-Hua Lyu, PhD, Associate Chief Physician, Senior Researcher, Department of Radiation, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. winlttljh@163.com

Received: May 18, 2026
Revised: June 8, 2026
Accepted: July 2, 2026
Published online: November 15, 2026
Processing time: 163 Days and 20.6 Hours

Abstract

BACKGROUND

Definitive chemoradiotherapy is the standard treatment for advanced esophageal squamous cell carcinoma (ESCC); however, marked prognostic heterogeneity exists and simple predictive biomarkers are lacking. Although skeletal muscle density (SMD) reflects muscle quality, its posttreatment prognostic value and age-dependent modifying effect in ESCC remain unclear.

AIM

To explore the prognostic significance of post-treatment SMD (post-SMD) and to clarify the age-related interaction in patients with ESCC undergoing definitive chemoradiotherapy.

METHODS

Altogether, 255 eligible ESCC patients were retrospectively enrolled. Post-SMD was calculated using L3 vertebral-level abdominal computed tomography images. Additionally, multivariate logistic regression and restricted cubic spline were utilized to analyze the influencing factors and nonlinear age-post-SMD correlation. Moreover, survival analyses and Cox regression were performed to assess the prognostic value, followed by the construction and validation of an age-subgroup prognostic model.

RESULTS

In the entire cohort, lower post-SMD was significantly associated with worse survival (P = 0.034). A nonlinear relationship was identified between age and post-SMD, with 64 years established as the inflection point (P = 0.016). Consequently, the prognostic impact of post-SMD was highly age-dependent. It served as a significant predictor of poor survival exclusively in patients aged < 64 years (P = 0.020) but not in those ≥ 64 years (P = 0.439). Multivariate analysis confirmed that higher post-SMD was an independent protective factor for survival (hazard ratio = 0.633, P = 0.006). Based on these findings, we developed a prognostic model incorporating post-SMD specifically for patients under 64 years. This model demonstrated excellent performance in distinguishing high-risk patients (P < 0.001), exhibiting high discriminatory power [12-month area under the curve (AUC) = 0.820; 36-month AUC = 0.867], good calibration, and providing a positive net clinical benefit in decision curve analysis.

CONCLUSION

In this study cohort, post-SMD is a vital prognostic biomarker, and age acts as a core effect modifier in evaluating its prognostic significance. This finding can provide references for precise risk stratification and individualized management of the corresponding population.

Keywords: Esophageal squamous cell carcinoma; Chemoradiotherapy; Skeletal muscle density; Muscle quality; Prognosis

Core Tip: This study enrolled 255 esophageal squamous cell carcinoma (ESCC) patients treated with definitive chemoradiotherapy to explore the prognostic role of post-treatment skeletal muscle density (post-SMD). We innovatively identified a nonlinear correlation between age and post-SMD, with 64 years as the optimal cut-off inflection point. Post-SMD exhibited an age-dependent prognostic modifying effect: Reduced post-SMD independently predicted inferior survival exclusively in patients aged < 64 years, while no significant prognostic correlation was observed in elderly patients ( ≥ 64 years). A tailored prognostic model incorporating post-SMD was established for young ESCC patients, which presented favorable discrimination, calibration, and net clinical benefit.