Combined low muscle mass and body mass index for prognosis in esophageal squamous cell carcinoma patients receiving immunochemoradiotherapy

doi:10.4251/wjgo.123631

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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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Retrospective Cohort Study

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): 123631
Published online Nov 15, 2026. doi: 10.4251/wjgo.123631

Combined low muscle mass and body mass index for prognosis in esophageal squamous cell carcinoma patients receiving immunochemoradiotherapy

Ling Xiao, Lin-Jie Li, Jia-Hua Lyu, Shi-Chuan Zhang, Long Liang

Ling Xiao, Lin-Jie Li, Jia-Hua Lyu, Shi-Chuan Zhang, Long Liang, Department of Radiation, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, Sichuan Province, China

Co-first authors: Ling Xiao and Lin-Jie Li.

Co-corresponding authors: Shi-Chuan Zhang and Long Liang.

Author contributions: Xiao L handled conceptualization, project administration, resources, and supervision; Xiao L and Li LJ managed data curation and visualization, they contributed equally to this article, they are the co-first authors of this manuscript; Xiao L and Lyu JH took charge of methodology; Lyu JH oversaw software; Xiao L, Li LJ, Lyu JH, Zhang SC, and Liang L contributed to investigation, validation, writing original draft, and writing review and editing; Liang L handled funding acquisition; Zhang SC and Liang L contributed equally to this article, they are the co-corresponding authors of this manuscript; 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 Medical Ethics Committee of Sichuan Cancer Hospital, approval No. SCCHEC-02-2020-019.

Informed consent statement: Informed consent was obtained from all subjects involved in the study.

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 datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Long Liang, Associate Chief Physician, Department of Radiation, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No. 55 Section 4, Renmin South Road, Chengdu 610041, Sichuan Province, China. lianglong@scszlyy.org.cn

Received: May 25, 2026
Revised: July 20, 2026
Accepted: September 4, 2026
Published online: November 15, 2026
Processing time: 157 Days and 19 Hours

Abstract

BACKGROUND

Locally advanced esophageal squamous cell carcinoma is widely treated with curative immunochemoradiotherapy. While low muscle mass (LMM) and body mass index (BMI) correlate with cancer prognosis, their joint prognostic role in this patient group is poorly defined.

AIM

To investigate the prognostic value of combined LMM and BMI stratification in this patient population, and evaluate the impact of body composition on survival.

METHODS

This single-center retrospective cohort study included 105 patients. Skeletal muscle index was calculated from computed tomography images at the L3 vertebral level, and LMM was defined using Asian-specific skeletal muscle index cutoff values. Restricted cubic spline analysis identified the optimal BMI cutoff. Survival was analyzed using the Kaplan-Meier method, and independent prognostic factors were identified using multivariable Cox regression.

RESULTS

Patients with LMM had significantly shorter progression-free survival (PFS) and overall survival (OS) than those without LMM (all P < 0.001). BMI-stratified analysis showed significant heterogeneity in the prognostic value of LMM. LMM did not distinguish survival in patients with BMI < 22.0 kg/m² but significantly predicted poorer PFS and OS in those with BMI ≥ 22.0 kg/m² (both P < 0.001). Although patients with both LMM and low BMI had the poorest survival, multivariable analysis identified normal muscle mass combined with high BMI as an independent protective factor for PFS (hazard ratio = 0.316, 95% confidence interval: 0.147-0.678; P = 0.003) and OS (hazard ratio = 0.265, 95% confidence interval: 0.119-0.588; P = 0.001).

CONCLUSION

Among patients with esophageal squamous cell carcinoma receiving immunochemoradiotherapy, LMM has greater prognostic value in those with a high BMI. Combined assessment of LMM and BMI improves risk stratification and may facilitate individualized treatment planning.

Keywords: Esophageal squamous cell carcinoma; Immunochemoradiotherapy; Skeletal muscle index; Low muscle mass; Body mass index

Core Tip: In this retrospective study of 105 patients with esophageal squamous cell carcinoma receiving immunochemoradiotherapy, we found that the prognostic value of low muscle mass is highly dependent on body mass index (BMI). Low muscle mass served as a strong independent adverse prognostic factor only in patients with BMI ≥ 22.0 kg/m², but showed no predictive efficacy in individuals with lower BMI, demonstrating marked BMI-dependent heterogeneity. This finding provides a novel basis for personalized risk stratification and clinical management of esophageal squamous cell carcinoma patients.