Abstract Background and purpose The prognostic role of preoperative psoas muscle index (PMI) among esophageal cancer patients undergoing the surgery remains unclear. This study aimed to identify the association of preoperative PMI with postoperative clinical outcomes in surgical esophageal cancer patients. Methods The PubMed, Web of Science and EMBASE databases were searched up to March 19, 2026. Primary outcome was the survival including the overall survival (OS) and disease-free survival (DFS). Secondary outcome was the postoperative complication such as the anastomotic leak and pneumonia. Hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were combined to assess the relationship of PMI with primary and secondary outcomes, respectively. Results Seventeen studies with 3813 patients were included. As for primary outcomes, pooled results demonstrated that lower PMI was significantly related to worse OS (HR = 1.72, 95% CI: 1.31–2.26, P < 0.001) and DFS (HR = 2.15, 95% CI: 1.46–3.16, P < 0.001) and subgroup analyses based on the tumor type and neoadjuvant therapy manifested consistent results. As for secondary outcomes, it was identified that preoperative PMI was associated with the risk of postoperative complication (OR = 1.92, P < 0.001), anastomotic leak (OR = 2.08, P < 0.001), pneumonia (OR = 2.56, P < 0.001), arrhythmia (OR = 1.73, P < 0.001), cardiac complication (OR = 2.11, P = 0.04), dysphagia (OR = 4.05, P = 0.03) and mortality (OR = 2.85, P < 0.001). Conclusion Preoperative PMI was significantly associated with postoperative clinical outcomes and lower PMI indicated shortened survival and increased risk of complication in esophageal cancer patients undergoing the surgery.
Ji et al. (Thu,) studied this question.