Impact of Body Composition on Clinical Outcomes in Patients with Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Immunotherapy Plus Chemotherapy

Abstract

AIM: Some studies have reported that body composition profiles affect clinical outcomes of multidisciplinary treatments in several types of cancers; however, a paucity of data exists on the association in neoadjuvant immunotherapy. In the present study, we aimed to investigate the effect of body composition on the clinical outcomes of patients with esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant immunotherapy plus chemotherapy (nICT).

METHODS: Clinicopathological data and computed tomography (CT) images of 85 patients with locally advanced ESCC who underwent esophagectomy after nICT were collected. At diagnosis and before surgery, the CT scan of the third lumbar vertebra was chosen to evaluate the skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), the subcutaneous and the visceral adiposity index. The relationships between body composition and tumor response after nICT and postoperative complications were analyzed.

RESULTS: The clinical stage (Odds Ratio (OR) 0.345, 95% confidence interval (CI) 0.141–0.844, p = 0.020) and change in SMI (∆SMI, OR 1.394, 95% CI 1.061–1.832, p = 0.017) were associated with tumor remission after nICT. Moreover, the multivariate logistic analysis revealed that ∆SMI (OR 0.598, 95% CI 0.433–0.828, p = 0.002) was associated with the incidence of postoperative complications. Patients with ∆SMI <–1 had a higher rate of postoperative complications (56% vs 15%, p < 0.001).

CONCLUSIONS: For ESCC, ∆SMI is associated with the pathological response after nICT and postoperative complications. Further analysis is needed to clarify whether nutritional intervention during neoadjuvant therapy increases SMI and thus improves clinical outcomes.