What question did this study set out to answer?

To evaluate the relationship between masseter muscle index preservation during chemoradiotherapy and survival outcomes compared to psoas muscle index in esophageal carcinoma patients.

April 27, 2026Open Access

Masseter muscle change during chemoradiotherapy for esophageal cancer: survival and immunonutritional associations compared with the psoas muscle index

Key Points

To evaluate the relationship between masseter muscle index preservation during chemoradiotherapy and survival outcomes compared to psoas muscle index in esophageal carcinoma patients.
Retrospective analysis of 78 esophageal squamous cell carcinoma patients undergoing chemoradiotherapy followed by esophagectomy.
Measured masseter and psoas muscle indices on CT scans and assessed immunonutritional markers preoperatively and postoperatively.
Analyzed associations using ANCOVA and evaluated survival outcomes with Kaplan–Meier methods.
Better maintenance of masseter muscle index during chemotherapy correlated with improved overall survival, showing borderline significance.
Greater loss in psoas muscle index was associated with worse recurrence-free survival and declines in BMI, GNRI, and albumin levels over time.

Abstract

Treatment-related muscle loss is common in esophageal squamous cell carcinoma (ESCC). The masseter reflects chewing–swallowing musculature; therefore, we evaluated whether preserving the masseter muscle index (ΔMMI) during preoperative chemoradiotherapy (CRT) relates more to survival and immunonutritional change, than preserving the psoas muscle index (ΔPMI). The subjects of this retrospective analysis were 78 ESCC patients who underwent CRT followed by esophagectomy. MMI and PMI were measured on contrast-enhanced CT at baseline (TP0) and post-CRT (TP1). Immunonutritional markers were assessed at TP0–TP2 (3 months postoperatively, ± 14 days) based on percent change (Δ). Associations with interval changes were tested with ANCOVA, adjusted for baseline, age, and sex. Overall survival (OS) and recurrence-free survival (RFS) were evaluated by Kaplan–Meier using median-split Δ over TP0→TP1. Better maintenance of ΔMMI during CRT was related to better OS (borderline) and favorable profiles; namely, improved BMI maintenance and lower Glasgow Prognostic Score (GPS), over TP0→TP1. In contrast, greater ΔPMI loss did not separate OS, but was associated with worse RFS and consistent deterioration in the indices of BMI, geriatric nutritional risk index (GNRI), and albumin, through TP0→TP2. Preserving ΔMMI during CRT relates to survival and immunonutritional stability, complementing ΔPMI as a systemic marker of decline. Incorporating masseter imaging into routine assessment and testing MMI-guided perioperative support warrants prospective evaluation.

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