González SC, Ramirez CA, Holgado E, Couñago F. From simple body mass index to lifesaving action: Linking low muscle mass, late diagnosis, and survival in chemoradiotherapy-treated esophageal cancer. World J Clin Oncol 2026; 17(6): 119908 [DOI: 10.5306/wjco.119908]
Corresponding Author of This Article
Felipe Couñago, MD, Attending Doctor, Department of Radiation Oncology, GenesisCare-San Francisco de Asís University Hospital, Calle Joaquín Costa 28, Madrid 28002, Spain. felipe.counago@genesiscare.es
Research Domain of This Article
Oncology
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editorial
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González SC, Ramirez CA, Holgado E, Couñago F. From simple body mass index to lifesaving action: Linking low muscle mass, late diagnosis, and survival in chemoradiotherapy-treated esophageal cancer. World J Clin Oncol 2026; 17(6): 119908 [DOI: 10.5306/wjco.119908]
World J Clin Oncol. Jun 24, 2026; 17(6): 119908 Published online Jun 24, 2026. doi: 10.5306/wjco.119908
From simple body mass index to lifesaving action: Linking low muscle mass, late diagnosis, and survival in chemoradiotherapy-treated esophageal cancer
Sara Cristina González, Carmen Aida Ramirez, Esther Holgado, Felipe Couñago
Sara Cristina González, Carmen Aida Ramirez, Esther Holgado, Department of Medical Oncology, GenesisCare-San Francisco de Asís University Hospital, Madrid 28002, Spain
Felipe Couñago, Department of Radiation Oncology, GenesisCare-San Francisco de Asís University Hospital, Madrid 28002, Spain
Author contributions: González SC contributed to the review of the literature, the discussion and design of the manuscript; Ramirez CA, Holgado E, and Couñago F contributed to writing and editing the manuscript; and all authors contributed to this paper.
AI contribution statement: Grok (developed by xAI) was used, Grok was used exclusively for language polishing and grammatical style improvement, specifically in the Abstract section. We confirm that the scientific content, interpretation of results, and all original ideas in the manuscript are entirely the work of the authors.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Felipe Couñago, MD, Attending Doctor, Department of Radiation Oncology, GenesisCare-San Francisco de Asís University Hospital, Calle Joaquín Costa 28, Madrid 28002, Spain. felipe.counago@genesiscare.es
Received: February 11, 2026 Revised: February 25, 2026 Accepted: April 20, 2026 Published online: June 24, 2026 Processing time: 132 Days and 22.1 Hours
Abstract
In the challenging landscape of esophageal squamous cell carcinoma (ESCC), where late diagnosis often brings progressive dysphagia, feeding difficulties, and chronic caloric-protein deficits that accelerate muscle wasting even before treatment begins, Xiao et al offer a compelling insight in the World Journal of Clinical Oncology. Their retrospective analysis of 360 patients undergoing definitive chemoradiotherapy reveals that baseline body mass index (BMI) is a powerful, readily available predictor of low muscle mass (LMM). Each additional BMI unit is linked to roughly a 39% lower odds of LMM (odds ratio: 0.613; 95%CI: 0.531-0.707), with a clear inflection point around 21.5 kg/m2 marking heightened risk below this threshold. What truly stands out is the synergistic prognostic impact: Patients burdened by both low BMI and LMM face the bleakest outlook, with a median overall survival of only 17 months. This underscores that LMM is far more than a nutritional byproduct — it acts as an independent driver of poorer treatment tolerance, heightened toxicities, and reduced survival in locally advanced ESCC. These observations open a practical window for action in everyday oncology practice. A simple BMI measurement at diagnosis can serve as an immediate, zero-cost alert to prompt detailed body composition evaluation (ideally via pretreatment computed tomography) and swift multidisciplinary intervention. Early nutritional reinforcement — through hypercaloric, high-protein oral nutritional supplements (ONS) delivering ≥ 1.5-2.0 g protein/kg ideal body weight daily — has been shown in dedicated trials to preserve weight, BMI, albumin, and prealbumin levels while attenuating radiation esophagitis, myelosuppression, and other toxicities during radiotherapy or chemoradiotherapy in ESCC patients. Meta-analyses further support that high-protein ONS reduces complications and aids lean mass maintenance in high-sarcopenia-risk cancers such as esophageal cancer. When oral intake falters due to tumor-related dysphagia, enteral routes become essential, complemented by individualized dietitian guidance and frequent reassessments. Adding supervised resistance training (2-3 sessions/week) where performance status allows provides a vital non-nutritional countermeasure against sarcopenia progression. By viewing BMI and LMM not merely as prognostic signals but as modifiable targets, we can shift toward more proactive, personalized supportive care — potentially transforming outcomes in one of oncology’s most demanding diseases.
Core Tip: In the challenging landscape of esophageal squamous cell carcinoma (ESCC), where late diagnosis often brings progressive dysphagia, feeding difficulties, and chronic caloric-protein deficits that accelerate muscle wasting even before treatment begins, Xiao et al offer a compelling insight. Baseline body mass index emerges as a simple yet potent predictor of low muscle mass in ESCC patients facing chemoradiotherapy, highlighting opportunities for early nutritional and exercise interventions to mitigate poor survival outcomes.
