This single-center retrospective study (n=334) compared preoperative psoas muscle index (PMI) vs. skeletal muscle index (SMI), both measured on CT at L3, for predicting postoperative pulmonary complications (PPCs) and 5-year OS/RFS in patients undergoing esophagectomy for thoracic esophageal cancer (January 2016–March 2024).
PPCs occurred in 110 patients (32.9%). Low PMI was independently associated with PPCs on multivariable analysis (OR 2.17, 95% CI 1.16–4.07; p=0.02), while low SMI was not (OR 0.90, 95% CI 0.46–1.77; p=0.76). Low PMI correlated with worse unadjusted 5-year OS (66.3% vs. 77.8%; p=0.02) and RFS (p=0.04), but these associations were attenuated after multivariable adjustment (OS HR 1.16, p=0.58; RFS HR 1.42, p=0.13).
- Single-center, predominantly male (78%) Japanese cohort limits generalizability and sex-specific conclusions. - Cutoff values were derived from non-esophagectomy populations (gastric cancer for SMI; liver donor adults for PMI), potentially misclassifying patients. - Muscle quality, myosteatosis, and functional status were not assessed; temporal changes in surgical technique over the 8-year enrollment period may confound results.
Measure preoperative PMI on routine CT at L3 to flag esophagectomy patients at higher risk for pulmonary complications — especially pneumonia — and consider PMI-guided prehabilitation referral. Do not rely on PMI alone to counsel patients on long-term survival, as its prognostic value disappears after adjusting for other factors.
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