Body mass index predicts low muscle mass in esophageal squamous cell carcinoma patients undergoing chemoradiotherapy

doi:10.5306/wjco.v17.i4.116601

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World Journal of Clinical Oncology

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Retrospective Cohort Study

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World J Clin Oncol. Apr 24, 2026; 17(4): 116601
Published online Apr 24, 2026. doi: 10.5306/wjco.v17.i4.116601

Body mass index predicts low muscle mass in esophageal squamous cell carcinoma patients undergoing chemoradiotherapy

Ling Xiao, Yu-Di Liu, Xue Zhang, Shi-Chuan Zhang, Jia-Hua Lyu

Ling Xiao, Yu-Di Liu, Xue Zhang, 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 610041, Sichuan Province, China

Co-first authors: Ling Xiao and Yu-Di Liu.

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

Author contributions: Xiao L was responsible for conceptualization, project administration, resources, and supervision; Xiao L and Liu YD managed data curation and visualization; they contributed equally to this article and are the co-first authors; Zhang X oversaw software; Xiao L, Liu YD, and Zhang SC were responsible for methodology; Lyu JH handled funding acquisition; Xiao L, Liu YD, Zhang X, 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, and they are the co-corresponding authors of this manuscript; all authors thoroughly reviewed and endorsed the final manuscript.

Institutional review board statement: This study was approved by the Medical 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: 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, No. 55 Section 4, Renmin South Road, Chengdu 610041, Sichuan Province, China. winlttljh@163.com

Received: November 18, 2025
Revised: December 12, 2025
Accepted: January 21, 2026
Published online: April 24, 2026
Processing time: 157 Days and 14.5 Hours

Abstract

BACKGROUND

Radiotherapy-induced toxicity and low muscle mass (LMM) significantly compromise treatment efficacy and survival in patients with esophageal squamous cell carcinoma (ESCC). Although body mass index (BMI) is a simple nutritional screening tool, its utility in predicting LMM in patients with ESCC remains unclear.

AIM

To investigate the association between baseline BMI and LMM prevalence and to evaluate the impact of LMM on survival outcomes in ESCC patients undergoing chemoradiotherapy.

METHODS

In this retrospective cohort study, 360 consecutive patients with ESCC treated with chemoradiotherapy at Sichuan Cancer Hospital from 2012 to 2023 were enrolled. LMM was assessed using skeletal muscle index derived from L3-level computed tomography images based on validated sex-specific cutoff values. Multivariable logistic regression was performed to analyze the association between BMI and LMM. A Cox proportional hazards model was used to assess the association between LMM and overall survival (OS) after adjusting for key confounders, including age, sex, clinical stage, and treatment regimen.

RESULTS

The prevalence of LMM was 23.0% in the patient cohort. Multivariable analysis showed that each 1-unit increase in BMI was associated with a 38.7% reduction in the odds of LMM (odds ratio: 0.613; 95% confidence interval: 0.531-0.707; P < 0.001). Patients with LMM had significantly shorter median OS than those without LMM (17.0 months vs 28.7 months; P < 0.001). The subgroup with combined low BMI and LMM had the poorest prognosis (median OS: 17.0 months). Baseline BMI was an independent predictor of LMM in patients with ESCC undergoing chemoradiotherapy and was significantly correlated with survival.

CONCLUSION

A combined evaluation of BMI and LMM enables the early identification of high-risk individuals, underscoring the importance of routine pretreatment assessment and timely nutritional and functional interventions to improve clinical outcomes.

Keywords: Esophageal squamous cell carcinoma; Body mass index; Low muscle mass; Prognosis; Chemoradiotherapy

Core Tip: Baseline body mass index (BMI) is a strong, independent predictor of low muscle mass (LMM) in patients with esophageal squamous cell carcinoma undergoing chemoradiotherapy. Higher BMI is associated with a significantly lower risk of LMM and improved survival. The combination of low BMI and LMM serves as a simple and effective composite marker for identifying high-risk patients with the poorest prognosis, highlighting the need for early nutritional and functional interventions to improve clinical outcomes.