ArticleFrontiers in nutrition2026
Standardized sarcopenia assessment should be incorporated into prognosis analysis of esophageal cancers: a prospective cohort study lasting 8 years.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The prognosis value of preoperative sarcopenia in esophageal cancer patients undergoing surgical resection have rarely been prospectively investigated. The necessity of a standardized sarcopenia assessment-including muscle mass, muscle strength, and physical performance-has not been tested. Methods: This prospective cohort study assessed the appendicular skeletal muscle mass index (ASMI), handgrip strength, and gait speed to classify participants as normal, pre-sarcopenia, or sarcopenia. The prognostic value of sarcopenia for overall survival (OS) and disease-free survival (DFS) was evaluated using propensity score matching, multivariable analysis, and subgroup analysis. The additive contribution of each muscle criterion to survival prediction was assessed using SHapley Additive exPlanations. Results: This study included 212 participants, with a median survivor follow-up of 91.8 months. Sarcopenia risk, including both pre-sarcopenia and sarcopenia, was identified as an independent prognostic factor for poor OS and DFS. These prognostic values remained significant across almost all patient subgroups. Incorporating the sarcopenia classification system into nomograms based on clinical cancer stage improved prediction efficacy for both OS and DFS. Additionally, although the three dimensions of muscle assessment were independently associated with OS and DFS, gait speed showed the largest contribution to survival prediction, while ASMI and handgrip strength showed comparably slightly inferior contributions. Conclusion: Sarcopenia assessment is recommended for incorporation into the prognosis analysis of surgically treated esophageal cancer patients. Comprehensive assessment of muscle mass, muscle strength, and physical performance is necessary for definitive diagnosis, severity classification, and effective prediction. Trial registration: Identifier, ChiCTR 1,800,017,792.
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