Abstract
: Introduction: The aim of the study was to investigate the influence of sarcopenia and hypoalbuminemia on overall survival in patients with esophageal cancer. Methods: Data from 138 patients treated for esophageal cancer at the Institute of Radiation Oncology, Bulovka University Hospital, Prague, Czech Republic, between 2009 and 2018 were retrospectively analyzed. Sarcopenia was assessed using the skeletal muscle index (SMI) derived from staging CT scans at the level of the L3 vertebra. Results: SMI was assessed in 129 (93.5%) patients and baseline albumin levels were available in 114 (82.6%) patients. The median overall survival was 9 months (range 1–154 months). Sarcopenia was detected in 80 patients (58.0%) and hypoalbuminemia in 38 patients (27.5%). Notably, 68.8% of sarcopenic patients had a normal or higher BMI, highlighting the limited ability of BMI alone to identify nutritionally compromised patients. Both sarcopenia and hypoalbuminemia were significantly associated with worse overall survival on Kaplan-Meier analysis (sarcopenia: p = 0.049; hypoalbuminemia: p = 0.007). On univariate Cox regression, sarcopenia showed a non-significant trend (HR 1.393, 95% CI 0.967–2.006; p = 0.075), while hypoalbuminemia was significantly associated with overall survival (HR 0.574, 95% CI 0.384–0.859; p = 0.007); neither factor retained independent prognostic significance on multivariate analysis. Conclusion: Sarcopenia and hypoalbuminemia were associated with worse overall survival in our cohort of patients with esophageal cancer on univariate analysis. Given the study's limitations, these findings should be regarded as hypothesis-generating and warrant confirmation in larger, prospective cohorts.