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

BACKGROUND

Myosteatosis, a marker of fatty infiltration in skeletal muscle, has emerged as a potential 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 [1.13-1.88], p = 0.004; I 2 = 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 [0.77-2.18], p = 0.34; I 2 = 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.