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<p>Survival prediction in patients with esophageal cancer is receiving a lot of attention from sarcopenia, myosteatosis, and systemic immune-inflammatory index (SII). The aim of this study was to investigate the survival prediction value of these parameters in esophageal cancer patients treated with immune checkpoint inhibitors (ICIs). Retrospective analysis of 178 patients with esophageal cancer who received immunotherapy and CT imaging. X-tile plots were utilized to determine optimal survival thresholds for skeletal muscle density (SMD), skeletal muscle index (SMI), and SII. The relationship between these parameters and patients’ overall survival (OS) and progression-free survival (PFS) was explored by Cox regression modeling and survival curve analysis. For OS, the Fine-Gray test was used to analyze competing risks. In addition, correlation and interaction analyses were performed on these indicators. Sarcopenia (mOS 10.3 months vs. 23.6 months; <i>P</i> &lt; 0.001), and myosteatosis (mOS 13.0 months vs. 23.4 months; <i>P</i> = 0.008), high SII (14.4 months vs. 40.7 months; <i>P</i> = 0.002) were associated with poor OS. Multifactorial regression showed that sarcopenia (HR: 2.15; 95%CI: 1.19 ~ 3.88; <i>P</i> = 0.012), myosteatosis (HR: 2.34; 95%CI: 1.31 ~ 4.18; <i>P</i> = 0.004), and high SII (HR: 1.91; 95%CI: 1.15 ~ 3.18; <i>P</i> = 0.013) were the independent risk factors for OS in patients with esophageal cancer, but not for PFS. No significant association was found between sarcopenia, myosteatosis, or a high SII and non-cancer mortality in the competing risk model. In addition, there was a low positive correlation (<i>r</i> = 0.219, <i>P</i> = 0.004) and interaction (<i>p</i> = 0.008) between sarcopenia and myosteatosis. The SMI-SMD-SII score was established, and OS was significantly shorter in patients with score ≥ 2 than in patients with score = 0 and 1 (<i>p</i> &lt; 0.001). This study found that sarcopenia, myosteatosis, and SII correlate significantly with survival in patients with advanced esophageal cancer receiving immunotherapy. However, the OS-PFS discrepancy may be confounded by subsequent therapies and does not directly reflect initial efficacy. Prospective studies are needed to validate these findings and inform personalized treatment.</p>

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Sarcopenia, myosteatosis and systemic immunoinflammatory index in the prediction of survival in patients undergoing immunotherapy for esophageal cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月11日

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  • Yanjing Zeng,
  • Jinmei Chen,
  • Liuyu Li,
  • Xinpeng Wang,
  • Ying Ye,
  • Tingjie Xiong,
  • Wenmin Ying,
  • Zhichao Fu

摘要

Survival prediction in patients with esophageal cancer is receiving a lot of attention from sarcopenia, myosteatosis, and systemic immune-inflammatory index (SII). The aim of this study was to investigate the survival prediction value of these parameters in esophageal cancer patients treated with immune checkpoint inhibitors (ICIs). Retrospective analysis of 178 patients with esophageal cancer who received immunotherapy and CT imaging. X-tile plots were utilized to determine optimal survival thresholds for skeletal muscle density (SMD), skeletal muscle index (SMI), and SII. The relationship between these parameters and patients’ overall survival (OS) and progression-free survival (PFS) was explored by Cox regression modeling and survival curve analysis. For OS, the Fine-Gray test was used to analyze competing risks. In addition, correlation and interaction analyses were performed on these indicators. Sarcopenia (mOS 10.3 months vs. 23.6 months; P < 0.001), and myosteatosis (mOS 13.0 months vs. 23.4 months; P = 0.008), high SII (14.4 months vs. 40.7 months; P = 0.002) were associated with poor OS. Multifactorial regression showed that sarcopenia (HR: 2.15; 95%CI: 1.19 ~ 3.88; P = 0.012), myosteatosis (HR: 2.34; 95%CI: 1.31 ~ 4.18; P = 0.004), and high SII (HR: 1.91; 95%CI: 1.15 ~ 3.18; P = 0.013) were the independent risk factors for OS in patients with esophageal cancer, but not for PFS. No significant association was found between sarcopenia, myosteatosis, or a high SII and non-cancer mortality in the competing risk model. In addition, there was a low positive correlation (r = 0.219, P = 0.004) and interaction (p = 0.008) between sarcopenia and myosteatosis. The SMI-SMD-SII score was established, and OS was significantly shorter in patients with score ≥ 2 than in patients with score = 0 and 1 (p < 0.001). This study found that sarcopenia, myosteatosis, and SII correlate significantly with survival in patients with advanced esophageal cancer receiving immunotherapy. However, the OS-PFS discrepancy may be confounded by subsequent therapies and does not directly reflect initial efficacy. Prospective studies are needed to validate these findings and inform personalized treatment.