{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T23:57:02Z","timestamp":1791244622365,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low skeletal muscle index (SMI) may identify host vulnerability in patients receiving intensive cancer therapy. However, its association with treatment tolerance and outcomes during neoadjuvant immunochemotherapy (nICT) for oesophageal squamous cell carcinoma (OSCC) remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicentre retrospective cohort included 461 patients with locally advanced OSCC who initiated nICT between 2020 and 2023; 404 underwent oesophagectomy. Pretreatment SMI at the third lumbar vertebra was measured by two blinded radiologists. Low SMI was defined using sex\u2010specific outcome\u2010derived cutoffs, with sensitivity analyses using published thresholds. Neoadjuvant treatment tolerance grade (NAT\u2010TG) was used as a composite measure of treatment tolerance and feasibility, integrating treatment modification and failure to undergo curative surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 461 patients (mean age, 61.2\u2009\u00b1\u20097.3\u2009years; 21.3% female), low SMI was present in 121 (26.2%) and was independently associated with an unfavourable NAT\u2010TG composite (NAT\u2010TG2\u20133 vs. NAT\u2010TG1; adjusted OR, 2.48; 95% CI, 1.62\u20133.82;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The association persisted after excluding six progression\u2010related surgical omissions (adjusted OR, 2.51; 95% CI, 1.59\u20133.95;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The overall distribution of treatment\u2010related adverse event severity differed between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012), with grade \u2265\u20093 events occurring in 36.4% of patients with low SMI and 22.9% of those without low SMI. In the surgical population, low SMI was independently associated with severe postoperative complications (adjusted OR, 2.92; 95% CI, 1.51\u20135.63;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). During a median follow\u2010up of 43\u2009months, 165 deaths occurred. The 1\u2010year mortality rate in the intention\u2010to\u2010treat population was 8.5% (95% CI, 5.9%\u201311.0%). In the primary intention\u2010to\u2010treat model, low SMI was associated with poorer overall survival (adjusted HR, 2.36; 95% CI, 1.67\u20133.33;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Associations were also observed for surgical overall survival (adjusted HR, 1.91; 95% CI, 1.31\u20132.80) and disease\u2010free survival (adjusted HR, 1.57; 95% CI, 1.11\u20132.22). Results were generally consistent when published SMI thresholds were applied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pretreatment low SMI was associated with less favourable nICT tolerance and feasibility, a higher incidence of severe postoperative complications and poorer survival. CT\u2010derived skeletal muscle assessment may complement baseline risk stratification, while intervention strategies require prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70392","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:05:26Z","timestamp":1790834726000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low Skeletal Muscle Index Predicts Neoadjuvant Immunochemotherapy Tolerance and Survival in Oesophageal Squamous Cell Carcinoma"],"prefix":"10.1002","volume":"17","author":[{"given":"Yizhou","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery Fujian Medical University Union Hospital  Fuzhou China"},{"name":"Key Laboratory of Cardio\u2010Thoracic Surgery (Fujian Medical University) Fujian Province University  Fuzhou China"},{"name":"National Key Clinical Specialty of Thoracic Surgery  Fuzhou China"},{"name":"Clinical Research Center for Thoracic Tumors of Fujian Province  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2064-8715","authenticated-orcid":false,"given":"Maohui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Fujian Medical University Union Hospital  Fuzhou China"},{"name":"Key Laboratory of Cardio\u2010Thoracic Surgery (Fujian Medical University) Fujian Province University  Fuzhou China"},{"name":"National Key Clinical Specialty of Thoracic Surgery  Fuzhou China"},{"name":"Clinical Research Center for Thoracic Tumors of Fujian Province  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyuan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Fujian Medical University Union Hospital  Fuzhou China"},{"name":"Key Laboratory of Cardio\u2010Thoracic Surgery (Fujian Medical University) Fujian Province University  Fuzhou China"},{"name":"National Key Clinical Specialty of Thoracic Surgery  Fuzhou China"},{"name":"Clinical Research Center for Thoracic Tumors of Fujian Province  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingqiang","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery The First Affiliated Hospital of Xiamen University  Fujian China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongcong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Quanzhou First Hospital  Fujian China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4651-7852","authenticated-orcid":false,"given":"Hongjin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Longyan First Hospital  Fujian 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