European Journal of Surgical Oncology · Dec 31, 2025
Impact of preoperative knee extension muscle strength on prognosis in older cancer patients with resectable esophageal cancer
By Yanagisawa T, Harada T, Tsuji T et al.
INTRODUCTION: Older patients with esophageal cancer (EC) have a poor prognosis, and there is a global need for the development of assessment tools and appropriate supportive care during cancer treatment. Knee extension muscle strength (KEMS) is associated with physical frailty in older adults. However, the impact of KEMS on clinical outcomes is unclear in older patients with EC. This study aimed to investigate the prognostic impact of KEMS on 3-year overall survival (3-yr OS) in older patients with EC. MATERIALS AND METHODS: This was a single-center retrospective cohort study of patients aged 70 years or older with EC who had undergone esophagectomy from September 2015 and January 2020. The most significant cutoffs of preoperative KEMS were defined using the log-rank test for 3-yr OS by sex. The prognostic impact of low KEMS was determined by univariate and multivariate Cox proportional hazards models adjusted for potential confounding factors. RESULTS: 150 patients with a mean age of 74.7 years (standard deviation: 3.9) were analyzed. The cutoff of KEMS was 380 N for men and 240 N for women. Low preoperative KEMS significantly impacted 3-yr OS [adjusted hazard ratio: 3.894 (95 % confidence interval: 1.350-11.229); p = 0.009] adjusted for age, sex, skeletal muscle mass index, Charlson comorbidity index, clinical stage, pathological T stage, and surgical technique. CONCLUSION: Low preoperative KEMS significantly impacted 3-yr OS in older patients with EC. Long-term postoperative care as well as perioperative rehabilitation for older EC patients with physical frailty may be particularly important for health and prognosis.