OESOPHAGEAL cancer survival following immunotherapy is strongly associated with body composition and inflammatory status, according to a retrospective study evaluating sarcopenia, myosteatosis, and systemic immune inflammatory index in treated patients.
Study Design and Patient Outcomes
This retrospective analysis included 178 patients with oesophageal cancer who received immunotherapy and underwent computed tomography imaging. The study assessed skeletal muscle index, skeletal muscle density, and systemic immune inflammatory index to evaluate their association with overall survival and progression free survival. Optimal survival thresholds were determined using X tile plots. Survival outcomes were analysed using Cox regression modelling and survival curve analysis, while the Fine Gray test was applied to assess competing risks for overall survival. Correlation and interaction analyses were also performed.
Patients with sarcopenia had significantly shorter median overall survival compared with those without sarcopenia at 10.3 months versus 23.6 months with p<0.001. Myosteatosis was also associated with reduced survival at 13.0 months compared with 23.4 months with p=0.008. A high systemic immune inflammatory index was linked to poorer overall survival at 14.4 months versus 40.7 months with p=0.002. None of these parameters showed a significant association with progression free survival.
Oesophageal Cancer Survival and Independent Risk Factors
Multivariable regression analysis identified sarcopenia, myosteatosis, and high systemic immune inflammatory index as independent risk factors for oesophageal cancer survival. Sarcopenia was associated with a hazard ratio of 2.15 with 95% CI: 1.19–3.88; p=0.012. Myosteatosis demonstrated a hazard ratio of 2.34 with 95% CI: 1.31–4.18; p=0.004. A high systemic immune inflammatory index was also independently associated with worse outcomes with a hazard ratio of 1.91 with 95% CI: 1.15–3.18; p=0.013. No significant associations were observed between these variables and non-cancer mortality in competing risk analysis.
Composite Scoring and Clinical Implications
A low positive correlation was observed between sarcopenia and myosteatosis with r=0.219 and p=0.004, alongside a significant interaction effect with p=0.008. Based on these findings, a combined skeletal muscle index, skeletal muscle density, and systemic immune inflammatory index score was developed. Overall survival was significantly shorter in patients with scores of two or higher compared with those scoring zero or one with p<0.001.
The authors conclude that sarcopenia, myosteatosis, and systemic immune inflammatory index are clinically relevant prognostic indicators in patients with advanced disease receiving immunotherapy. They note that discrepancies between overall survival and progression free survival may be influenced by subsequent therapies and may not directly reflect initial treatment efficacy. Prospective studies are required to validate these findings and support personalised treatment approaches.
Reference
Zeng Y et al. Sarcopenia, myosteatosis and systemic immunoinflammatory index in the prediction of survival in patients undergoing immunotherapy for esophageal cancer. Scientific Reports. 2026; https://doi.org/10.1038/s41598-025-34513-2.
