Association of body composition, tumor-specific assessment, and patient demographics at diagnosis with 90-day and overall survival in esophageal cancer patients in a global population.

Body composition characteristics varied significantly by global region, sex, age, and histological subtype in esophageal cancer patients undergoing esophagectomy.

• 1716 patients were recruited from 14 high-volume centers across three global regions: North America (22%), Europe (55%), and Asia (23%).
• Patients were predominantly male (79.5%) and adenocarcinoma was the most common histological subtype (66.6%).
• Global region, sex, age, and histological subtype were all significantly associated with levels of muscle and adiposity (P < 0.001).
• Data were collected from centers operating between 2007 and 2019.

Squamous cell carcinoma was associated with significantly lower levels of skeletal muscle and adiposity compared to adenocarcinoma, independent of global region, sex, and age.

• The association between squamous cell carcinoma and lower muscle and adiposity levels was confirmed using a multivariable linear regression model (P < 0.001).
• This finding was independent of global region, sex, and age.
• Adenocarcinoma was the most common histological subtype, comprising 66.6% of the cohort.

Reduced skeletal muscle at diagnosis was associated with increased 90-day mortality and reduced long-term overall survival.

• Skeletal muscle was assessed from CT images at the L3 axial level acquired routinely at diagnosis, analyzed using a standardized protocol.
• The association with 90-day mortality was statistically significant.
• Reduced skeletal muscle was also associated with reduced long-term survival.

Excess total adiposity at diagnosis was associated with increased 90-day mortality and reduced long-term overall survival.

• Visceral and subcutaneous adipose tissues were measured from CT L3 axial images at diagnosis using a standardized protocol.
• Both 90-day mortality and long-term overall survival were negatively affected by excess total adiposity.
• Total adiposity assessment was included alongside skeletal muscle in the survival prediction model.

A multivariable prediction model incorporating skeletal muscle, total adiposity, and other tumor- and patient-specific variables was constructed for survival prediction.

• The prediction model included skeletal muscle and total adiposity at diagnosis as key body composition variables.
• Additional tumor-specific and patient demographic variables were incorporated into the model.
• The model was described as allowing 'convenient survival prediction' for clinical use.
• The study authors state findings 'can inform future guidelines for the use of body composition assessment in routine clinical practice.'

Body composition measurements were standardized across all 14 international centers using CT images at the L3 axial level acquired at diagnosis.

• Skeletal muscle, visceral adipose tissue, and subcutaneous adipose tissue were all measured from L3 axial CT images.
• A standardized protocol was applied across all participating centers.
• Images were those acquired routinely at diagnosis rather than requiring additional imaging.