Association of sarcopenia with pathologic complete response in esophageal squamous cell carcinoma patients undergoing neoadjuvant immunochemotherapy

Sarcopenia can affect the efficacy of neoadjuvant chemotherapy or chemoradiotherapy for esophageal squamous cell carcinoma. However, the extent of this relationship in patients treated with neoadjuvant immunochemotherapy has not been fully explored. A retrospective cohort study was conducted on 150 patients with locally advanced esophageal squamous cell carcinoma who underwent two or three cycles of neoadjuvant immunochemotherapy, followed by surgical resection. We analyzed the correlation between clinicopathological factors—including sarcopenia before neoadjuvant immunochemotherapy and excessive muscle loss during neoadjuvant therapy—and the occurrence of pathologic complete response. Before neoadjuvant immunochemotherapy, 55.3% of patients were classified as having sarcopenia, and this proportion increased to 68.0% after neoadjuvant immunochemotherapy. A total of 20.7% of patients (31/150) achieved pathologic complete response. Multivariate logistic regression analyses revealed that sarcopenia before neoadjuvant immunochemotherapy (odds ratio = 2.696, P = 0.023) and excessive muscle loss during treatment (odds ratio = 3.999, P = 0.038) were independent predictors of failure to achieve pathologic complete response after neoadjuvant immunochemotherapy. The study identified sarcopenia before neoadjuvant immunochemotherapy and excessive muscle loss during treatment as important adverse factors associated with a lower likelihood of achieving pathologic complete response in esophageal squamous cell carcinoma patients undergoing neoadjuvant immunochemotherapy. Consequently, our findings underscore the crucial role of preoperative sarcopenia in influencing treatment outcomes of neoadjuvant immunochemotherapy.