Sarcopenic psoas muscle surface area predicts short and long-term mortality for oesophageal cancer patients
Original Article

Sarcopenic psoas muscle surface area predicts short and long-term mortality for oesophageal cancer patients

Emma Annukka Tiainen1 ORCID logo, Erkki-Ville Sakari Wirta2, Tuula Marjatta Tyrväinen2, Johanna Marja Laukkarinen1,2, Mika Tapani Ukkonen1,3

1Tampere University, Tampere, Finland; 2Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; 3Wellbeing Services of Central Finland, Jyväskylä, Finland

Contributions: (I) Conception and design: All authors; (II) Administrative support: MT Ukkonen, EVS Wirta; (III) Provision of study materials or patients: MT Ukkonen, EVS Wirta, EA Tiainen; (IV) Collection and assembly of data: EA Tiainen, EVS Wirta, MT Ukkonen; (V) Data analysis and interpretation: EA Tiainen, MT Ukkonen; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Emma Annukka Tiainen, MD. Tampere University, Kalevantie 4, 33100 Tampere, Finland. Email: emma.tiainen@tuni.fi.

Background: Oesophagectomy is associated with high morbidity and mortality. Although efforts have been made to develop risk assessment tools, prognostic features that can be easily and objectively assessed from preoperative computed tomography are rarely used. Here we sought to evaluate whether the loss of skeletal muscle mass can predict short and long-term mortality after oesophagectomy.

Methods: This study included consecutive patients with oesophageal cancer that underwent oesophagectomy at Tampere University Hospital from January 2007 to December 2018. Reviewers, blinded to both clinical details and postoperative outcomes, measured the average cross-sectional area of the bilateral psoas muscles at the L3 vertebra level. These measurements were then correlated with clinicopathological data and survival metrics.

Results: A total of 97 patients [median age 64 (range, 43–78) years; 20% female] were enrolled, with a median follow-up time of 1,307 (range, 2–1,540) days. The median psoas muscle areas (PMAs) were 809 [interquartile range (IQR), 679–1,065] mm2 among males and 508 (IQR, 382–661) mm2 among females. Twenty-seven percent of patients were considered to have sarcopenic psoas muscle surface area. During neoadjuvant therapy, muscle area decreased on 92% of patients by median of 70 (IQR, 38–158) mm2 (P<0.001). Patients with lower PMA had worse survival (90-day survival 77% vs. 99%, P<0.001; and 5-year survival 31% vs. 49%, P=0.02). Surprisingly, obesity was associated with improved survival in non-sarcopenic patients (5-year survival 71% vs. 44%, P<0.001).

Conclusions: Sarcopenic patients had lower survival rates. Thus, enhancing preoperative care could improve outcomes in these fragile patients.

Keywords: Oesophageal cancer (OC); oesophagectomy; oesophagus; sarcopenia

Submitted Nov 05, 2024. Accepted for publication Mar 28, 2025. Published online May 28, 2025.

doi: 10.21037/jtd-24-1919

Highlight box

Key findings

• We found that sarcopenia was prognostic for poor short-term and long-term survival after oesophagectomy for cancer. Obesity was a protective feature for non-sarcopenic patients.

What is known and what is new?

• Preoperative sarcopenia has been associated with a poor prognosis in gastrointestinal cancers.

• The assessment of sarcopenia is easy and can aid the clinician in decision-making, especially among frail older patients.

What is the implication, and what should change now?

• Sarcopenic patients had lower survival rates. Thus, enhancing preoperative care could improve outcomes in these fragile patients.

Introduction

Oesophageal cancer (OC) is the sixth most common cause of cancer-related mortality, and in the Western world the incidence is rapidly increasing (1,2). Its aggressive nature makes OC one of the most fatal cancers, with 5-year survival rates reported to range between 15% and 25% (3). The mainstay curative treatment of OC is oesophagectomy, which is technically complex and associated with a high risk of adverse outcomes. As oesophagectomy is associated with significant risks, multiple risk assessment tools have been developed to improve patient selection when selecting appropriate treatment for patients with cancer. One of those is the preoperative assessment of sarcopenia (1).

Sarcopenia is defined as a progressive disorder involving the loss of skeletal muscle mass, function, and quality (4). It has long been thought to be age-related, but the development seems to begin earlier in life. Sarcopenia is associated with multiple adverse health outcomes, such as falls, frailty, and increased mortality. The aetiology is multifactorial and may be associated with poor nutrition; physical inactivity; metabolic, endocrine, or neurological disorders; cardiorespiratory diseases; cancer; or iatrogenic reasons (4-6).

Several studies have shown that computed tomography (CT)-assessed low muscle area is associated with post-oesophagectomy pulmonary complications, lower long-term survival, infections, thromboembolic complications, and an extended length of hospital stay (1-3,7-9). Even though the association between this and the patient’s prognosis has been widely studied, its role as a predictive factor remains controversial (1,7,10-12). The aim of this study was to assess the association of sarcopenic psoas muscle surface area with postoperative mortality. We present this article in accordance with the STROBE reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1919/rc).

Methods

Each consecutive patient with OC who underwent oesophagectomy and gastric tube reconstruction with intrathoracic double-layer hand-sewn anastomosis at Tampere University Hospital between January 2007 and December 2018 was reviewed. Patients were identified from the institutional database by retrieving all cases associated with the Nordic Medico-Statistical Committee (NOMESCO) classification of surgical procedures (Version 1.13) code “JCC10” (transthoracic partial oesophagectomy without interposition). Patients without histopathologically proven OC or an oesophagectomy with no intrathoracic anastomosis were excluded.

Patient-, disease-, and operation-related details were recorded for each patient. Potential risk factors for postoperative mortality were retrieved from the hospital records, including age, gender, co-morbidities, history of smoking, American Society of Anesthesiologists (ASA) classification, and tumour characteristics. Tumours were histopathologically staged according to the criteria of the International Union Against Cancer (UICC) (13). Cancer stages were divided into early stage (complete response, Tis, and stage 1), stage 2, stage 3, and stage 4.

All preoperative CT scans were reviewed by two consultants in gastro-intestinal surgery (M.TU., E.V.S.W.) who were blinded to patient- and operation-related details and postoperative outcomes. The CT images were reviewed using medical imaging workstations (Sectra Workstation, version 21.2, Sectra AB, Linköping, Sweden). All included patients had undergone a preoperative body CT scan and a restaging scan after neoadjuvant therapy.

Determining sarcopenia

Measurements of the psoas muscle area (PMA) were performed on transverse axial slices at the caudal level of the third lumbar vertebra. Total cross-sectional area was calculated automatically and presented in square millimetres (mm2). The overall muscle density was calculated as the mean of both sides at the same vertebral level. The impact of neoadjuvant therapy on PMA was assessed by calculating differences between the staging CT and restaging CT after neoadjuvant therapy. Determining sarcopenia is presented in Figure 1.

Figure 1 Determining sarcopenia from CT-scans (example patient, previously healthy patient). CT, computed tomography.

Considering sarcopenic obesity, patients were divided into four groups. Group 1 had neither obesity determined by body mass index (BMI) (BMI >30 kg/m2) nor sarcopenia. Group 2 was obese but did not have sarcopenia. Group 3 was sarcopenic without obesity, and Group 4 was both obese and sarcopenic.

Statistical analysis

Statistical analysis was performed using SPSS for Windows statistical software version 27.0 by using the Chi square test or Fisher’s exact test to compare categorical data. As non-categorical variables were non-normally distributed (presented as medians with min to max), Mann-Whitney U test was used to find association with non-categorical variables. Correlation between two non-categorical variables was assessed by using Pearson correlation. The limit of sarcopenic PMA was determined from a receiver operating characteristics (ROC) curve drawn in relation to 90-day mortality, with best sensitivity and specificity for 90-day mortality. If the patient received neoadjuvant treatment, the muscle surface area value was obtained from the treatment response CT scan. A Kaplan-Meier survival plot was used to illustrate the postoperative mortality after oesophagectomy. Statistical significance was set at P<0.05.

Ethical aspects

The study was performed according to the Helsinki Declaration and its subsequent amendments, and approval from the Medical Research Ethics Committee at Tampere University Hospital (No. R21505) was obtained. Informed consent was taken from all the patients.

Results

A total of 97 patients with a median age of 64 (range, 43–78) years and strong male predominance (80%) were included. The median follow-up time after surgery was 1,307 (range, 2–1,540) days. The patient demographics and tumour characteristics are presented in Table 1.

Table 1

Patient- and disease-specific characteristics of the study population

Variables Values
Age (years) 64 (43–78)
Female 19 [20]
Smoking history†
   Yes 42 [43]
   No 33 [34]
ASA physiological score
   1–2 45 [46]
   3–4 52 [54]
Preoperative neoadjuvant therapy
   None 33 [34]
   Chemotherapy 45 [46]
   Radiochemotherapy 19 [20]
Tumour histology†
   Adenocarcinoma 71 [73]
   Squamous cell carcinoma 17 [18]
   Other‡ 5 [5.2]
Stage†
   Early stage (complete response, Tis, stage 1) 32 [33]
   2 21 [22]
   3 37 [38]
   4 6 [6]
T-class†
   T0§ 19 [20]
   T1 12 [12]
   T2 15 [15]
   T3 40 [41]
   T4 11 [11]
   Tx 1 [1]
N-class†
   N0 51 [53]
   N1 26 [27]
   N2 14 [14]
   N3 4 [4]
   Nx 2 [2]

Data are presented as median (min to max) or n [%]. †, data was missing for the following variables; smoking history for 22 patients, tumour histology for 4 patients, stage for 1 patient, and N-class for 2 patients; ‡, including neuroendocrine tumours and carcinoma NOS (with complete response); §, complete response to neoadjuvant therapy. ASA, American Society of Anesthesiologists; NOS, not otherwise specified.

Survival according to clinicopathological variables is shown in Table 2. The overall 90-day, 1-year, and 5-year survival rates were 93%, 79%, and 44%, respectively. Cancer stage was not associated with short-term, 30-day (P=0.74) and 90-day (P=0.87), survival. One year after the surgery 89% of patients with stage 0, I and II disease were alive, compared to 73% of those with stage III disease and 50% of those with stage IV disease (P=0.13). Corresponding survival at 5 years were 89%, 67%, 35% and 0% (P=0.02). Older age predicted higher 30-day (P=0.01), 90-day (P=0.006), 1-year (P=0.002) and 5-year (P=0.03) mortality.

Table 2

Short-term survival according to clinicopathological variables

Variables 30-day 90-day
Alive Dead P value Alive Dead P value
Age 62 (43–78) 73 (72–78) 0.01 62 (43–78) 72 (66–78) 0.006
   <65 years 52 [100] 0 [0.0] 0.059 52 [100] 0 [0.0] 0.003
   ≥65 years 42 [93] 3 [6.7] 38 [84] 7 [16]
Sex 0.04 0.11
   Female 17 [90] 2 [11] 16 [84] 3 [16]
   Male 77 [99] 1 [1.3] 74 [95] 4 [5.1]
Smoking history† 0.86 0.46
   No 41 [98] 1 [2.4] 40 [95] 2 [4.8]
   Yes 32 [97] 1 [3.0] 30 [91] 3 [9.1]
ASA 0.10 0.08
   1–2 49 [94] 3 [5.8] 46 [89] 6 [12]
   3–4 45 [100] 0 [0.0] 44 [98] 1 [2.2]
BMI 0.057 0.49
   <18.5 kg/m2 10 [100] 0 [0.0] 10 [100] 0 [0.0]
   18.5–<30 kg/m2 70 [99] 1 [1.4] 66 [93] 5 [7.0]
   ≥30 kg/m2 14 [88] 2 [13] 14 [88] 2 [13]
Albumin† 0.45 0.89
   <34 g/L 51 [98] 1 [1.9] 48 [92] 4 [7.7]
   ≥34 g/L 41 [95] 2 [4.7] 40 [93] 3 [7.0]
Tumour histology† 0.09 0.54
   Adenocarcinoma 70 [99] 1 [1.4] 67 [94] 4 [5.6]
   Squamous cell carcinoma 15 [88] 2 [12] 15 [88] 2 [12]
   Other‡ 5 [100] 0 [0.0] 5 [100] 0 [0.0]
Neoadjuvant therapy 0.050 0.86
   None 30 [91] 3 [9.1] 30 [91] 3 [9.1]
   Chemotherapy 45 [100] 0 [0.0] 42 [93] 3 [6.7]
   Radiochemotherapy 19 [100] 0 [0.0] 18 [95] 1 [5.3]
T-class† 0.04 0.72
   Complete response§ 19 [100] 0 [0.0] 18 [95] 1 [5.3]
   T1 10 [83] 2 [17] 10 [83] 2 [17]
   T2 14 [93] 1 [6.7] 14 [93] 1 [6.7]
   T3 40 [100] 0 [0.0] 38 [95] 2 [5.0]
   T4 11 [100] 0 [0.0] 10 [91] 1 [9.1]
N-class† 0.86 0.45
   N0 50 [98] 1 [2.0] 48 [94] 3 [5.9]
   N1 25 [96] 1 [3.8] 25 [96] 1 [3.8]
   N2 14 [100] 0 [0.0] 13 [93] 1 [7.1]
   N3 4 [100] 0 [0.0] 3 [75] 1 [25]
Stage† 0.74 0.87
   Early stage 31 [97] 1 [3.2] 30 [94] 2 [6.7]
   2 21 [100] 0 [0.0] 20 [95] 1 [4.8]
   3 36 [97] 1 [2.7] 35 [95] 2 [5.4]
   4 6 [100] 0 [0.0] 5 [83] 1 [17]

Data are presented as median (min to max) or n [%]. †, data was missing for the following variables: smoking history for 22 patients, albumin for 2 patients, tumour histology for 4 patients, stage for 1 patient, and N-class for 2 patients; ‡, including neuroendocrine tumours and carcinoma NOS (with complete response); §, complete response to neoadjuvant therapy; , complete response, Tis, stage 1. ASA, American Society of Anesthesiologists; BMI, body mass index; NOS, not otherwise specified.

Sarcopenia

The median PMAs were 809 [interquartile range (IQR), 679–1,065] mm2 among males and 508 (IQR, 382–661) mm2 among females. PMA was not associated with cancer stage (P=0.32), neither there was correlation with PMA and patients’ BMI (P=0.26) and age (P=0.21). During neoadjuvant therapy, PMA decreased on 92% of patients by median of 70 (IQR, 38–158) mm2. Patients’ gender, preoperative albumin levels and cancer stage were not associated with higher decrease in PMA, neither there was correlation with PMA decrease and patients’ age and BMI. According to the ROC analysis, the cut-off value for sarcopenic PMA was 526 mm2 among females and 658 mm2 among males.

Association with sarcopenic PMA and mortality are presented in Table 3 and Figure 2. Sarcopenic PMA predicted lower 30-day (89% vs. 100%, P=0.004), 90-day survival (77% vs. 99%, P<0.001), 1-year (69% vs. 83%, P=0.11) and 5-year survival (31% vs. 49%, P=0.02). The mortality of patients with sarcopenic PMA remained higher also if only those with stage 0–I were included into analysis—the corresponding survival rates in stage 0–1 patients were 86% vs. 100% (P=0.06), 71% vs. 100% (P=0.006), 57% vs. 96% (P=0.006) and 43% vs. 72% (P=0.15). Obesity (BMI >30 kg/m2) was associated with better survival in non-sarcopenic patients (5-year survival 71% vs. 44%, P<0.001). Respective changes of PMA in those dead vs. alive after 30-day, 90-day, 1-year and 5-year were median 39 vs. 71 mm2 (P=0.71), 39 vs. 80 mm2 (P=0.14), 40 vs. 83 mm2 (P=0.20) and 65 vs. 88 mm2 (P=0.22).

Table 3

Survival table

Variables 90-day survival 5-year survival
N [deaths] % P value N [deaths] % P value
Sarcopenia <0.001 0.02
   sPMA 26 [6] 77 26 [18] 31
   Non-sPMA 71 [1] 99 71 [36] 49
Sarcopenic obesity <0.001 <0.001
   Non-sPMA & normal BMI 57 [1] 98 57 [32] 44
   Non-sPMA & obese 14 [0] 100 14 [4] 71
   sPMA & normal BMI 24 [4] 83 24 [16] 33
   sPMA & obese 2 [2] 0 2 [2] 0

Normal BMI: BMI <30 kg/m2; obese: BMI ≥30 kg/m2. BMI, body mass index; non-sPMA, non-sarcopenic psoas muscle surface area; sPMA, sarcopenic psoas muscle surface area.

Figure 2 5-year survival according to sarcopenia.

When categorized variables (including sarcopenic PMA, patients’ age and BMI and cancer stage) were inserted into multivariate analysis sarcopenic PMA was only variable independently associated with higher 90-day mortality [P=0.02; odds ratio (OR) =15.4; 95% confidence interval (CI): 1.6–146]. Older age predicted higher long-term mortality, as shown in Table 4.

Table 4

Association with patient characteristics and sarcopenia

Variables Sarcopenia (n=26), n [%] Non-sarcopenic (n=71), n [%] N (groups) P value
Age 0.003
   <65 years 8 [31] 46 [65] 54
   ≥65 years 18 [69] 25 [35] 43
Sex 0.005
   Female 10 [38] 9 [13] 19
   Male 16 [62] 62 [87] 78
Smoking history† 0.41
   Yes 6 [23] 27 [38] 33
   No 11 [42] 31 [44] 42
Tumour histology† 0.33
   Adenocarcinoma 17 [65] 54 [76] 71
   Squamous cell carcinoma 7 [27] 10 [14] 17
   Other 1 [4] 4 [6] 5
Albumin† 0.54
   <34 g/L 15 [58] 37 [52] 52
   ≥34 g/L 10 [38] 33 [46] 43
BMI 0.16
   <30 kg/m2 24 [92] 57 [80] 81
   ≥30 kg/m2 2 [8] 14 [20] 16
ASA score 0.16
   1–2 9 [35] 36 [51] 45
   3–4 17 [65] 35 [49] 52
Stage† 0.20
   Early stage 7 [27] 25 [35] 32
   2 8 [31] 13 [18] 21
   3 7 [27] 30 [42] 37
   4 3 [12] 3 [4] 6
T-class† 0.79
   T0 6 [23] 13 [18] 18
   Tis–T1 4 [15] 8 [11] 12
   T2 3 [12] 12 [17] 15
   T3 9 [35] 31 [44] 40
   T4 4 [15] 7 [10] 11
N-class† 0.15
   N0 12 [46] 39 [55] 50
   N1 8 [31] 18 [25] 26
   N2 2 [8] 12 [17] 14
   N3 2 [8] 2 [3] 4
Neoadjuvant therapy 0.17
   None 6 [23] 27 [38] 33
   Chemotherapy 12 [46] 33 [46] 45
   Radiochemotherapy 8 [31] 11 [15] 19

†, data was missing for the following variables: smoking history for 22 patients, albumin for 2 patients, tumour histology for 4 patients, stage for 1 patient, and N-class for 2 patients. ASA, American Society of Anesthesiologists; BMI, body mass index.

Discussion

The aim of our study was to clarify the effect of low PMA on short-term and long-term mortality after oesophagectomy for cancer. We found that low PMA was prognostic for worse survival. In addition, obesity was associated with improved survival in non-sarcopenic patients.

Malnutrition exacerbates sarcopenia by depriving the patient of essential nutrients needed for muscle maintenance and repair, accelerating muscle loss and functional decline. There is a well-known association between OC and malnutrition. Oesophageal obstruction by the tumour mass may cause dysphagia and reduced dietary intake. In the following catabolic state, muscle protein serves as the primary reservoir for amino acids used for gluconeogenesis, leading to muscle mass depletion. Also, cancer-induced systemic inflammation causes muscle degradation, and furthermore, highly metabolically active tumour cells compete for the available energy, promoting glycolysis (14). The risk for malignant processes increases along with ageing when reasons for primary sarcopenia, such as physical inactivity, loss of appetite, and reduced secretion of anabolic steroids, may have already deteriorated muscle mass (15). Not surprisingly, up to 75% of OC patients have been reported to have sarcopenia at the time of diagnosis. Preoperative treatments such as chemoradiotherapy or chemotherapy alone often precedes surgery, and this can further reduce muscle mass (7). Oesophagectomy itself is an extremely strenuous operation for patients and is associated with significant weight loss, malnutrition, and sarcopenia (10).

Preoperative sarcopenia has been associated with a poor prognosis in gastrointestinal (GI) cancers (16-24). However, the results remain controversial in OC patients. Grotenhuis et al. (12) enrolled 120 patients who underwent neoadjuvant chemotherapy and oesophagectomy for cancer and who had CT scans available. They found that overall morbidity and mortality rates did not differ significantly between sarcopenic and non-sarcopenic patients (12,25). Siegal et al. found that sarcopenia was neither associated with increased morbidity nor prognostic for overall survival after oesophagectomy (25). They performed a retrospective review on a database of oesophageal diseases at a single institute and enrolled 173 patients. It seems to be that one of the reasons for controversial reports is the inconsistency in methods for assessing sarcopenia (2). Nishigori et al. (7) and Siegal et al. (25) defined sarcopenia by normalizing the L3 muscle mass to the patients’ height and calculated the skeletal muscle mass index (cm2/m2 body surface area). Matsunaga et al. (9) had a group of 163 patients with OC, but they assessed body composition by using multifrequency bioelectrical impedance analysis (BIA) with InBody 720, which automatically measured various parameters. Similar to our approach, Grotenhuis et al. (12) measured the L3 muscle cross-sectional area, however they assessed total cross-sectional muscle area with cut-off limits of 52.4 cm2/m2 for men and 38.5 cm2/m2 body surface area for women. Radiological methods seem to be the gold standard when defining sarcopenia (15). Consistent with other reports, we found that the mortality was the highest among older sarcopenic patients (16,22,26).

Interestingly, our survival analysis suggested that obesity in non-sarcopenic patients may be a protective factor considering mortality. This phenomenon, called the obesity paradox, has been identified in several chronic diseases—for example, renal insufficiency, rheumatoid arthritis, and cardiovascular diseases—but also in several cancers (27,28). Generally, obesity in these studies is defined by using BMI as a measurement. In part this could be explained by the crudeness of BMI as a measure of body adipose tissue, because body composition varies with age, sex, and ethnicity (28,29). A high BMI can in some cases be related to better muscle mass, lesser sarcopenia explaining the improved survival. Other proposed reason for the obesity paradox in cancer patients could be that excess adipose tissue may act as a nutrient reserve that might be beneficial during cancer treatments (30). Obesity might also affect the pharmacokinetics of cancer treatment regimens favourably, and in some cancers, obesity has been associated with less aggressive characteristics. However, obesity is a well-known risk factor for cancer development, including in oesophageal adenocarcinoma cancers (31). Evidence of hormonal mechanisms, disturbed energy balance-driven cellular changes, and the inflammatory signalling of the adipose tissue have been found to participate in cancer progression, but the process is still incompletely understood (30).

We found that PMA decreased during neoadjuvant treatments. Yoon et al. (3) found that a change in skeletal muscle index predicted poor overall survival and recurrence-free survival. Thus, identifying sarcopenia in GI cancer patients would presumably be beneficial regarding the sarcopenia-associated risk for adverse events. Assessment of sarcopenia from routine CT scans required for the treatment plan is simple and provides useful information concerning the patient’s ability to endure, for example, preoperative treatments with the usually designated dosages. In addition, knowledge of patient body composition and ongoing sarcopenia enables the planning of treatment to provide nutritional support and other measures for the preservation of muscle mass and function more effectively.

Our study was not without limitations. First, it was a retrospective audit. The overall number of patients included in this study was relatively small, therefore causing limited sample sizes, especially in the subgroup analysis. Also, many studies have defined sarcopenia by using the values of Prado et al. (32), including patients with respiratory and GI malignancies. We decided to define our limit for the sarcopenia ROC-curve drawn in relation to the 90-day mortality and used different values for men and women. While the stage of the cancer did not seem to affect to the incidence of sarcopenia in these patients, the results would have been more convincing with a larger sample size. Our data consisted of only open procedures to minimize the confounding effect of different treatment techniques. In the future, it would be relevant to verify the results with cancer patients operated on using a minimally invasive technique. Among our strengths is that all patients were primarily treated at a single hospital, so there was little variability in treatment protocols. Furthermore, the demographic characteristics were accurately documented, and the follow-up time was sufficient for reliable conclusions. We defined sarcopenia by measuring the L3 cross-sectional area from CT scans, and since radiological measurements seem to be the gold standard when assessing sarcopenia, our methods are therefore reproducible.

Conclusions

In conclusion, we found that sarcopenia was prognostic for poor short-term and long-term survival after oesophagectomy for cancer. Obesity was a protective feature for non-sarcopenic patients. The assessment of sarcopenia is easy and can aid the clinician in decision-making, especially among frail older patients.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1919/rc

Data Sharing Statement: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1919/dss

Peer Review File: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1919/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1919/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was performed according to the Helsinki Declaration and its subsequent amendments, and approval from the Medical Research Ethics Committee at Tampere University Hospital (No. R21505) was obtained. Informed consent was taken from all the patients.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Cite this article as: Tiainen EA, Wirta EVS, Tyrväinen TM, Laukkarinen JM, Ukkonen MT. Sarcopenic psoas muscle surface area predicts short and long-term mortality for oesophageal cancer patients. J Thorac Dis 2025;17(5):2926-2936. doi: 10.21037/jtd-24-1919

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