The effects of neoadjuvant chemoradiotherapy-related frailty by analytic morphomics in esophageal cancer

Neoadjuvant chemoradiotherapy followed by surgery offers potential cure for locally advanced esophageal cancer. Yet, frailty often emerges post-therapy, heightening risks of delayed surgery and complications. Analytic morphomics, derived from computed tomography scans, quantifies body composition, reflecting nutritional and functional status. Our study delineates morphomic shifts post-neoadjuvant chemoradiotherapy and their impact on short-term outcomes. We retrospectively analyzed patients with esophageal cancer treated with neoadjuvant chemoradiotherapy followed by esophagectomy between 2007 and 2016. Clinical and morphomic data pre- and post- neoadjuvant chemoradiotherapy were collected, and changes were identified using paired comparisons. Delayed surgery and postoperative complications were evaluated using univariate and multivariable analyses. The study included 181 patients with esophageal cancer who received neoadjuvant chemoradiotherapy followed by surgery. Decreased bone mineral density, dorsal muscle group area and visceral adipose tissue area (all p < 0.001) were noted after neoadjuvant chemoradiotherapy. On multivariable Cox regression, a greater increase in subcutaneous fat area after neoadjuvant chemoradiotherapy (p = 0.04) was associated with delayed surgery. Increasing age was associated with overall (p = 0.03) and medical (p = 0.006) postoperative complications while a greater decrease in dorsal muscle group area after neoadjuvant chemoradiotherapy (p = 0.046) was associated with surgical complications. Body composition changes significantly after neoadjuvant chemoradiotherapy for esophageal cancer, indicating increasing frailty. Advanced age correlated with medical complications, while reduced dorsal muscle group area post-neoadjuvant chemoradiotherapy was linked to surgical complications. Utilizing analytic morphomics to evaluate post-neoadjuvant chemoradiotherapy body composition changes helps predict short-term outcomes and may refine esophagectomy patient selection.