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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Morphomics in esophageal cancer: Validation and association with muscular and cardiorespiratory fitness
Watson Hua-Sheng Tseng, Shu-Chun Huang, Stewart C Wang, Jules Lin, Peng Zhang, Yu-Chen Liu, Yin-Kai Chao, Chien-Hung Chiu
Watson Hua-Sheng Tseng, Department of Medical Education, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
Shu-Chun Huang, Department of Physical Medicine and Rehabilitation, New Taipei Municipal Tucheng Hospital, Chang Gung Memorial Hospital, New Taipei City 236043, Taiwan
Shu-Chun Huang, Yu-Chen Liu, Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
Shu-Chun Huang, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
Stewart C Wang, Peng Zhang, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
Jules Lin, Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI 48109, United States
Yin-Kai Chao, Chien-Hung Chiu, Division of Thoracic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
Co-first authors: Watson Hua-Sheng Tseng and Shu-Chun Huang.
Author contributions: Tseng WHS, Huang SC and Chiu CH designed the study; Tseng WHS, Huang SC and Zhang P analyzed the data; Tseng WHS and Huang SC drafted the manuscript; Chiu CH revised the manuscript; Liu YC contributed to data collection; Wang SC, Lin J and Chao YK provided project administration. All authors reviewed and approved the final version of the manuscript. Tseng WHS and Huang SC contributed equally to this work as co-first authors.
Supported by Chang Gung Memorial Hospital, Taiwan, No. CMRPG3N1171, No. CMRPG3N1172, No. CORPVVN0071, No. CMRPVVK0111-3 and No. CMRPVVL0121-3; and National Science and Technology Council, Taiwan, No. MOST 114-2314-B-182A-066-.
Institutional review board statement: This study was approved by the Institutional Review Board at Chang Gung Memorial Hospital, Linkou (No. 202500080B0).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data supporting the findings of this study are available from the corresponding author upon reasonable request at
happy9000000@gmail.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Chien-Hung Chiu, MD, Assistant Professor, Division of Thoracic Surgery, Chang Gung Memorial Hospital at Linkou, No. 5 Fu-Shing St. Kwei-Shan, Taoyuan 33305, Taiwan.
happy9000000@gmail.com
Received: April 18, 2025
Revised: May 22, 2025
Accepted: June 23, 2025
Published online: August 27, 2025
Processing time: 129 Days and 21.1 Hours
BACKGROUND
Morphomics, a computed tomography-based body composition assessment, helps predicting esophageal cancer outcomes, but its link to bioelectrical impedance analysis (BIA) and functional assessments such as hand grip strength (HGS) and cardiopulmonary exercise testing (CPET) remains unclear.
AIM
To investigate correlations between morphomics and BIA, HGS, CPET, and assess its ability to predict low cardiorespiratory fitness (CRF).
METHODS
Fifty esophageal cancer patients underwent multi-level morphomics, BIA, HGS, and CPET. Correlations were analyzed using heatmaps and scatter plots, and logistic regression assessed morphomic predictive value for low CRF.
RESULTS
T11 is the only level with complete morphomic data, making it the most applicable. To ensure reliability, T11 and its adjacent levels, T10-12, were included in the subsequent analysis. Dorsal muscle group volume from T10-12 morphomics all correlated positively with BIA muscle components (r = 0.56-0.68, all P < 0.001), HGS (r = 0.4-0.48, all P < 0.001), and CPET variables (r = 0.43-0.51, all P < 0.001). Subcutaneous fat area and visceral fat area from morphomics correlated with body fat percentage (r = 0.58-0.67, all P < 0.001) and negatively with CPET parameters (r = -0.33 to -0.52, all P < 0.05). Morphomics also showed potential in identifying low CRF, with an area under the receiver operating characteristic curve of 0.778.
CONCLUSION
T11 morphomics shows strong correlation with BIA, HGS, and CPET, and may serve as a practical tool for preoperative risk assessment in esophageal cancer patients.
Core Tip: This study explored the relationship between computed tomography-based morphomics and physical assessments, including bioelectrical impedance analysis, hand grip strength, and cardiopulmonary exercise testing in esophageal cancer patients. Morphomics at the eleventh thoracic vertebra level had the most complete data and showed strong correlations with muscle mass, strength, and exercise capacity. Fat measurements from morphomics were inversely related to exercise performance. Morphomics also demonstrated potential to identify patients with low cardiorespiratory fitness, highlighting its clinical potential as a reliable tool for assessing physical fitness and guiding personalized care in esophageal cancer.
