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Association between myosteatosis and survival of patients with esophageal and gastro-esophageal junction cancer: a meta-analysis

evidence-based-medicine
oncology
pathology
radiology-and-medical-imaging
metabolic-sciences

Abstract

Background: Myosteatosis, reflecting fatty infiltration in skeletal muscle, has emerged as a possible prognostic factor in various cancers. However, its association with survival in patients with esophageal cancer (EC) or gastro-esophageal junction cancer (GEC) remains uncertain. This meta-analysis aimed to evaluate the predictive value of myosteatosis for survival of this patient population.

Methods: A systematic search of PubMed, Embase, and Web of Science was conducted through May 14, 2025. Studies reporting overall survival (OS) and/or progression-free survival (PFS) in patients with EC or GEC, with outcomes stratified by baseline myosteatosis status, were eligible for inclusion. To account for inter-study variability, pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were estimated using random-effects models.

Results: Eleven cohort studies comprising 1,810 patients with EC or GEC were included. Myosteatosis was significantly associated with poorer OS (HR=1.46, 95% CI: 1.13 to 1.88, p =0.004; I²=76%). Subgroup analyses indicated consistent associations across study design, cancer type, age, sex, treatment modality, and analytic models (p for subgroup differences > 0.05). A stronger effect was observed when myosteatosis was assessed using intramuscular adipose tissue content rather than muscle attenuation (HR=2.29 vs. 1.30; p for subgroup difference=0.02). Myosteatosis was not significantly associated with PFS (HR=1.29, 95% CI: 0.77 to 2.18, p =0.34; I²=82%).

Conclusion: Baseline myosteatosis is associated with poorer OS in patients with EC or GEC. Muscle quality assessment may improve prognostic stratification in this population.

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