# Osteosarcopenia as a Predictor of Histopathologic Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer: a Retrospective Cohort Study

## TL;DR

This study shows that osteosarcopenia can predict how well esophageal cancer patients respond to neoadjuvant chemoradiotherapy.

## Contribution

The study identifies osteosarcopenia as an independent predictor of histopathologic response to NACRT in esophageal cancer.

## Key findings

- Osteosarcopenia was present in 39% of patients and linked to poorer NACRT response.
- NACRT effectiveness was higher in patients without osteosarcopenia and with favorable clinical factors.
- Osteosarcopenia independently correlated with histopathologic response but not with survival outcomes.

## Abstract

Predicting chemoradiotherapy (CRT) response in esophageal cancer is essential as outcomes vary among patients. This study aimed to evaluate the impact of osteosarcopenia on the effectiveness of neoadjuvant CRT (NACRT).

Ninety-five patients with advanced esophageal cancer who underwent surgical resection post-NACRT were included. Sarcopenia and osteopenia were determined using pre-NACRT skeletal muscle index and bone density at L3 and Th11 levels. Patients were categorized based on osteosarcopenia status.

Thirty-seven patients (39%) had osteosarcopenia. Among tumors, 49 (51.6%) were grade 1 (non-responders), 12 (12.6%) were grade 2, and 34 (35.8%) were grade 3 (responders). NACRT was significantly more effective in patients with above-median body mass index, shallow tumor depth, low squamous cell carcinoma antigen levels, and without osteosarcopenia. Osteosarcopenia was independently correlated with the histopathologic response to NACRT. No significant differences in overall or relapse-free survival were observed based on osteosarcopenia status.

Osteosarcopenia may predict NACRT response in esophageal cancer.