From simple body mass index to lifesaving action: Linking low muscle mass, late diagnosis, and survival in chemoradiotherapy-treated esophageal cancer

Table 1 Selected key evidence on the prognostic impact of low muscle mass/sarcopenia and the benefit of multimodal interventions in patients with esophageal squamous cell carcinoma undergoing chemoradiotherapy

Ref.	Study type	Main findings	Clinical implication
Xiao et al[14], 2026	Retrospective cohort study (n = 360)	Baseline BMI is a strong predictor of low muscle mass (OR: 0.613 per unit); BMI < 21.5 kg/m2 + LMM associated with median OS of 17 months	Simple BMI measurement at diagnosis can serve as a zero-cost screening tool
Fang et al[6], 2023	Systematic review and meta-analysis	Sarcopenia significantly associated with worse overall survival in esophageal cancer	Sarcopenia is an independent prognostic factor
Jogiat et al[7], 2022	Systematic review and meta-analysis	Sarcopenia reduces overall survival in unresectable ESCC treated with chemoradiotherapy (HR: 1.51)	Routine screening for sarcopenia is warranted
Yang et al[18], 2023/Qiu et al[19], 2020	RCTs/prospective trials	High-protein ONS preserves weight, BMI, albumin and reduces grade ≥ 3 esophagitis and myelosuppression	Early nutritional support improves treatment tolerance
Halliday et al[24], 2024/Sugimura et al[25], 2025	Prehabilitation studies	Multimodal prehabilitation (nutrition + resistance exercise) attenuates muscle loss during neoadjuvant or definitive therapy	Combined nutritional and exercise interventions are promising
Vongcharoenpol et al[26], 2025	Prospective cohort	Sarcopenia after concurrent chemoradiotherapy is common and associated with poor outcomes	Need for proactive muscle-preserving strategies

BMI: Body mass index; LMM: Low muscle mass; OS: Overall survival; ONS: Oral nutritional supplements; HR: Hazard ratio; RCT: Randomized controlled trial; ESCC: Esophageal squamous cell carcinoma; OR: Odds ratio.