# Prognostic value of the third thoracic vertebra skeletal muscle measurements in patients with digestive system malignancies: a comparative study with the third lumbar vertebra indices

## TL;DR

This study shows that measuring skeletal muscle at the T3 vertebra can predict outcomes in digestive cancer patients as effectively as the standard L3 vertebra.

## Contribution

The study introduces T3 as a reliable alternative to L3 for skeletal muscle assessment in cancer prognosis.

## Key findings

- T3 skeletal muscle measurements strongly correlate with L3 measurements (r = 0.833 for SMA, r = 0.747 for SMI).
- Lower T3 SMA and SMI are independently linked to higher mortality risk in digestive cancer patients.
- T3 measurements can effectively predict L3 SMA with high accuracy (adjusted R² = 0.829).

## Abstract

Skeletal muscle mass assessment using computed tomography (CT) is crucial for evaluating nutritional status and prognosis in cancer patients. While the third lumbar vertebra (L3) level is widely accepted for this purpose, not all patients undergo abdominal CT scans. This study aimed to explore the potential of the third thoracic vertebra (T3) level as an alternative measurement site. This retrospective study included 257 patients with digestive system malignancies. Skeletal muscle area (SMA) and skeletal muscle index (SMI) were measured at both T3 and L3 levels using CT scans. Correlation analyses, linear regression models, and cox regression analyses were performed to evaluate the relationship between T3 and L3 measurements and their prognostic value. Strong correlations were observed between T3 and L3 measurements (r = 0.833 for SMA, r = 0.747 for SMI). A multivariate linear regression model effectively predicted L3 SMA from T3 SMA (adjusted R² = 0.829). Cox regression analyses revealed that lower T3 SMA and SMI were independently associated with increased mortality risk. Patients in the lowest quartile of T3 SMA had significantly higher mortality risk compared to those in the highest quartile (HR = 5.82, 95% CI: 1.86–18.16, P = 0.002), after adjusting for confounders. Similar results were observed for T3 SMI and L3 measurements. T3 skeletal muscle measurements strongly correlate with L3 measurements and serve as independent prognostic factors in patients with digestive system malignancies. T3 measurements offer a viable alternative for assessing skeletal muscle mass and predicting prognosis when L3 measurements are unavailable.

The online version contains supplementary material available at 10.1038/s41598-026-37915-y.