ESTRO 2025 - Abstract Book

S1760

Clinical – Upper GI

ESTRO 2025

833

Digital Poster prognostic impact of sarcopenia and surgical timing in locally advanced esophageal squamous cell carcinoma receiving neoadjuvant chemoradiotherapy Guiyu Huang 1 , Qifeng Wang 1 , Xiaoli Tang 2 1 Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chendu, China. 2 Department of Comprehensive Ward, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chendu, China Purpose/Objective: Optimal timing for surgery after neoadjuvant chemoradiotherapy (NCRT) remains controversial, necessitating reliable preoperative indicators. This study examines how sarcopenia and surgical timing affect prognosis in locally advanced esophageal squamous cell carcinoma (LA-ESCC) patients. Material/Methods: This retrospective analysis included patients with LA-ESCC who underwent NCRT followed by surgery at three institutions in China between 2015 and 2023. Skeletal muscle area (SMA) at the third lumbar vertebra was measured before and after NCRT to calculate the skeletal muscle index (SMI). Sarcopenia was defined as SMI <52.4 cm²/m² for men and <38.5 cm²/m² for women. Time to surgery (TTS) was categorized into short (<42 days) and long (≥42 days) intervals. Survival curves were constructed using the Kaplan–Meier method and compared using a log rank test. Univariate and multivariate Cox regression models and propensity score matching (PSM) analysis were adopted in the prognostic analysis. Statistical significance was set as P value <0.05 in a two-tailed test. Results: A total of 415 patients were included, with the median age of 62 years (range 43-77years) and the male predominance (82.4%). The median TTS was 46 days (range 24-126 days). Over a median follow-up of 39.1 months (95%CI 36.3-41.9), 115 patients died, and the median PFS was 37.79 months(95%CI 35.3-40.6). The 5-year OS and PFS rates were 72.5% and 64.1%, respectively. Multivariate analysis showed that malnutrition and TTS were independent prognostic factors for both OS and PFS (P < 0.05) . The OS (78.2% vs 58.7%, HR 0.62, 95%CI 0.42 0.91, p = 0.01)and PFS (69% vs 52.1%, HR 0.68, 95%CI 0.48-0.97, p = 0.02) of patients with long TTS were better than those of patients with short TTS. Multivariate and PSM analyses revealed no significant survival difference between sarcopenic and non-sarcopenic groups. In the subgroup analysis , among sarcopenic patients, a long TTS was associated with significantly improved OS (77.2% vs 52.6%; HR 0.56; 95%CI 0.35-0.91; P = 0.01) and PFS (68.9% vs 47.4%; HR 0.62; 95%CI 0.4-0.96; P = 0.02). In contrast, no survival benefit was observed for TTS in non-sarcopenic patients (P > 0.05). Conclusion: While sarcopenia does not independently impact OS or PFS, patients with sarcopenia benefit from a longer surgical time interval after NCRT. Preoperative evaluation of muscle quality may aid in optimizing surgical timing to improve outcomes.

Keywords: Optimal surgical interval; Sarcopenia; EC

References: 1.Yang Y, Da J, Yuan J, Zha Y. One-year change in sarcopenia was associated with cognitive impairment among haemodialysis patients. J Cachexia Sarcopenia Muscle . Oct 2023;14(5):2264-2274. doi:10.1002/jcsm.13311. 2.Nilsson K, Klevebro F, Sunde B, et al. Oncological outcomes of standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer in the multicentre, randomised, controlled NeoRes II trial. Ann Oncol . Nov 2023;34(11):1015-1024. doi:10.1016/j.annonc.2023.08.010.