Prognostic Impact of Osteopenia in Patients with Resectable Esophageal Adenocarcinoma: A Retrospective Study

Introduction: Osteopenia, marked by low bone mineral density, is a sign of patient frailty and has been linked to poor survival in patients with esophageal squamous cell carcinoma. However, its impact on overall survival (OS) and disease-free survival (DFS) in patients with esophageal adenocarcinoma is still unclear. Aim: Our aim was to assess the impact of osteopenia on long-term survival in patients with resectable esophageal adenocarcinoma. Methods: This was a retrospective study (January 2014–December 2024) including patients with resectable Siewert I–II esophageal adenocarcinoma who underwent Ivor-Lewis esophagectomy. Osteopenia was defined as reduced bone mineral density (<160 Hounsfield units) measured at the level of the first lumbar vertebra on preoperative computed tomography scan. Results: Overall, 338 patients were included. The prevalence of osteopenia was 27.8%. Anastomotic leak (22.3% vs. 11.9%; p=0.04), pneumonia (17.1% vs. 6.9%; p=0.01), and 90-day mortality (8.5% vs. 2.1%; p=0.02) were higher in patients with osteopenia. On multivariate analysis, osteopenia was an independent predictor of pneumonia (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.06–1.86) and 90-day mortality (HR 1.35; 95% CI 1.12–1.95) but not anastomotic leak (HR 1.51; 95% CI 0.91–1.76). Patients with osteopenia had significantly lower 60-month OS probability (49.9% vs. 70.5%; p<0.001) and DFS probability (45.7% vs. 61.5%; p=0.002). Osteopenia independently predicted poorer OS (HR 2.03; 95% CI 1.54–2.95) and DFS (HR 1.51; 95% CI 1.12–2.35). Conclusions: Osteopenia may affect up to one-third of patients with esophageal adenocarcinoma. Osteopenia was independently associated with postoperative pneumonia and 90-day mortality and poor long-term survival. Patients with osteopenia have lower OS and DFS than those without osteopenia.