Impacts of sarcopenia on adverse events and prognosis in Chinese patients with esophageal cancer undergoing chemoradiotherapy

Jiaoyue Qu Yang Liu ^* Yin Yuan Zhao Yu ^* Jianming Ding ^* Zelai He ^* Gengming Wang ^*

• The First Affiliated Hospital of Bengbu Medical University, Bengbu 233000, Anhui, China, Bengbu, China

Background: Sarcopenia is a common indicator of systemic nutritional status in patients with cancer progression. This study investigated the impacts of sarcopenia on adverse effects and prognosis of sarcopenia on patients with esophageal cancer receiving chemoradiotherapy.The clinical data of 158 patients with initially diagnosed esophageal cancer who received chemoradiotherapy were collected, and nutritional indexes and inflammatory markers were calculated. The cross-sectional areas of the skeletal muscle, subcutaneous fat and visceral fat were calculated using computed tomography (CT) images of the midpoint of the third lumbar (L3) vertebra. The incidence of adverse events, response evaluation, 1-year and 3-year overall survival (OS) and progression-free survival (PFS) were compared between sarcopenia group and non-sarcopenia groups.Results: This study included 158 patients, 103 (71.5%) in the sarcopenia group and 45 (28.5%) in the non-sarcopenia group. The last follow-up date was January 31, 2024. The median follow-up time was 36 months for all patients. The chisquare test revealed no significant difference in the incidence of serious adverse events between the two groups. The complete response rates (CR) of patients in the sarcopenia and non-sarcopenia groups one month after chemoradiotherapy were 2.7% and 13.3%, respectively, p=0.017, and the difference was statistically significant. Moreover, the objective response rates (ORR) were 38.9% and 60.0%, respectively (χ 2 =5.770, p=0.016). The median survival time for all patients was 36 months [95% Confidence Interval CI 24-48]. Univariate analysis (Cox proportional risk model) showed that sarcopenia, KPS score, albumin level, T stage, and N stage were correlated with patients' OS. Multivariate analysis showed that sarcopenia (Hazard Ratio HR 2.84,], p=0.002), KPS score, albumin level and N stage were independent prognostic factors for OS.Conclusions: Sarcopenia reduced OS in patients with EC treated with chemoradiotherapy. It can be used as an independent indicator to predict the OS of such patients, which may help in developing optimal treatment strategies.