PD09.01. Impact of Sarcopenia, Myosteatosis and Cachexia on Surgical and Oncological Outcomes in Patients With Esophageal Cancer

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Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background Alterations in body composition, including sarcopenia, myosteatosis and cachexia, are increasingly recognized as negative prognostic factors in oncologic patients. However, the correlation between body composition, biochemical markers, and surgical and oncological outcomes in esophageal cancer remains incompletely defined. This study aimed to evaluate the association between CT-derived body composition parameters, nutritional and inflammatory biomarkers, and surgical and oncological outcomes in patients undergoing curative-intent esophagectomy. Methods A prospective clinical trial was conducted from 2014 to present, enrolling patients with esophageal or esophagogastric junction cancer undergoing curative-intent resection. Preoperative clinical, anthropometric, biochemical, and functional data were collected. Body composition was assessed using contrast-enhanced CT scans, applying the cut-offs published by Martin et al. In patients receiving neoadjuvant therapy, both pre-treatment and preoperative CT scans were analyzed to evaluate longitudinal changes in body composition. Patients were stratified according to low muscle mass, myosteatosis, and cancer cachexia. Postoperative complications and survival outcomes were analyzed. Results A total of 181 patients undergoing partial esophagectomy for cancer were included. Low muscle mass (55.8%), myosteatosis (38.1%) and cancer cachexia (66.3%) were frequent. Low muscle mass was associated with severe anastomotic leak (p = 0.034) and cardiovascular complications (p = 0.032), with limited impact on survival. Myosteatosis independently predicted major complications (p = 0.004) and urologic events (p = 0.017), showing a trend toward worse overall survival (OS) in the entire cohort (p = 0.11) and significantly reduced OS and disease-free survival (DFS) in adenocarcinoma (p = 0.02 and p = 0.04). Cancer cachexia was not associated with postoperative morbidity, but correlated with poorer OS and DFS (p = 0.04). Neoadjuvant therapy increased the prevalence of myosteatosis (p = 0.045) and cachexia (p < 0.001). Biochemically, prealbumin independently predicted myosteatosis (p < 0.001), while albumin was associated with cachexia (p < 0.001), highlighting their role as markers for alteration in body composition. Conclusion Body composition parameters show distinct clinical and prognostic implications in esophageal cancer. Integrating body composition assessment and nutritional biomarkers, beyond muscle quantity alone, into preoperative risk stratification may support early identification of high-risk patients to guide targeted multidisciplinary prehabilitation strategies to optimize perioperative outcomes and improve long-term outcomes.

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