Top

Published in:

Open Access 01-03-2018 | Original Article

Impact of body composition on outcome in patients with early breast cancer

Authors: Elise Deluche, Sophie Leobon, Jean Claude Desport, Laurence Venat-Bouvet, Julie Usseglio, Nicole Tubiana-Mathieu

Published in: Supportive Care in Cancer | Issue 3/2018

Abstract

Purpose

We investigated the impact of body composition on outcomes of patients with early breast cancer. Skeletal muscle mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and muscle fat infiltration or inter-muscular adipose tissue areas (IMAT), obtained by computed tomography (CT), were assessed.

Methods

A total of 119 female patients who had breast cancer were included in this retrospective study. The total skeletal muscle and fat tissue areas were evaluated in two adjacent axial slices obtained at the third lumbar vertebra by CT used for disease staging. The women were assigned to either a sarcopenia or non-sarcopenia group based on their skeletal muscle index (cut-off 41.0 cm²/m²). They also were classified into high and low VAT/SAT ratio groups and assigned to either the high or low IMAT index group. The association of the body composition parameters and prognosis was statistically analyzed.

Results

Among the 119 evaluable patients, 58 were sarcopenic (48.8%), 55 (46.2%) had a high VAT/SAT ratio, and 62 (52.1%) had a high IMAT index. Median follow-up was 52.4 months. Multivariate analysis revealed sarcopenia and IMAT index as independent prognostic factors for disease-free survival (p = 0.02 and p = 0.04, respectively) and overall survival (p = 0.05 and p = 0.02, respectively). BMI was not significantly associated with disease-free survival, but a trend was observed (p = 0.09).

Conclusions

Sarcopenia and IMAT index are independent prognostic factors in early breast cancer; therefore, assessing body composition could be a simple and useful approach to integrate into patient management.

Stewart B, Wild CP et al (2014) World cancer report 2014

Senesse P, Bachmann P, Bensadoun RJ et al (2014) Clinical nutrition guidelines of the French Speaking Society of Clinical Nutrition and Metabolism (SFNEP): summary of recommendations for adults undergoing non-surgical anticancer treatment. Dig Liver Dis. https://doi.org/10.1016/j.dld.2014.01.160

De Pergola G, Silvestris F (2013) Obesity as a major risk factor for cancer. J Obes 2013:291546. https://doi.org/10.1155/2013/291546 CrossRefPubMedPubMedCentral

Arce-Salinas C, Aguilar-Ponce JL, Villarreal-Garza C et al (2014) Overweight and obesity as poor prognostic factors in locally advanced breast cancer patients. Breast Cancer Res Treat 146:183–188. https://doi.org/10.1007/s10549-014-2977-8 CrossRefPubMed

Herlevic VC, Mowad R, Miller JK et al (2015) Breast cancer outcomes in a population with high prevalence of obesity. J Surg Res 198:371–376. https://doi.org/10.1016/j.jss.2015.03.088 CrossRefPubMed

von Drygalski A, Tran TB, Messer K et al (2011) Obesity is an independent predictor of poor survival in metastatic breast cancer: retrospective analysis of a patient cohort whose treatment included high-dose chemotherapy and autologous stem cell support. Int J Breast Cancer 2011:1–8. https://doi.org/10.4061/2011/523276 CrossRef

Chan DSM, Vieira AR, Aune D et al (2014) Body mass index and survival in women with breast cancer—systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol 25:1901–1914. https://doi.org/10.1093/annonc/mdu042 CrossRefPubMedPubMedCentral

Cecchini RS, Swain SM, Costantino JP et al (2016) Body mass index at diagnosis and breast cancer survival prognosis in clinical trial populations from NRG Oncology/NSABP B-30, B-31, B-34, and B-38. Cancer Epidemiol Prev Biomark 25:51–59. https://doi.org/10.1158/1055-9965.EPI-15-0334-T CrossRef

Gennari A, Amadori D, Scarpi E et al (2016) Impact of body mass index (BMI) on the prognosis of high-risk early breast cancer (EBC) patients treated with adjuvant chemotherapy. Breast Cancer Res Treat 159:79–86. https://doi.org/10.1007/s10549-016-3923-8 CrossRefPubMed

10.

Prado CMM, Lieffers JR, McCargar LJ et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635. https://doi.org/10.1016/S1470-2045(08)70153-0 CrossRefPubMed

11.

Mitsiopoulos N, Baumgartner RN, Heymsfield SB et al (1998) Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol Bethesda Md 85:115–122

12.

Rutten IJ, Dijk DP, Kruitwagen RF et al (2016) Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients. J Cachex Sarcopenia Muscle 7:458–466. https://doi.org/10.1002/jcsm.12107

13.

Anandavadivelan P, Brismar TB, Nilsson M et al (2016) Sarcopenic obesity: a probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr 35:724–730. https://doi.org/10.1016/j.clnu.2015.05.011 CrossRefPubMed

14.

Antoun S, Borget I, Lanoy E (2013) Impact of sarcopenia on the prognosis and treatment toxicities in patients diagnosed with cancer. Curr Opin Support Palliat Care 7:383–389. https://doi.org/10.1097/SPC.0000000000000011 CrossRefPubMed

15.

Lodewick TM, van Nijnatten TJA, van Dam RM et al (2015) Are sarcopenia, obesity and sarcopenic obesity predictive of outcome in patients with colorectal liver metastases? HPB 17:438–446. https://doi.org/10.1111/hpb.12373 CrossRefPubMed

16.

Martin L, Birdsell L, Macdonald N et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol Off J Am Soc Clin Oncol 31:1539–1547. https://doi.org/10.1200/JCO.2012.45.2722 CrossRef

17.

Shachar SS, Williams GR, Muss HB, Nishijima TF (2016) Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer Oxf Engl 57:58–67. https://doi.org/10.1016/j.ejca.2015.12.030 CrossRef

18.

Fabbro ED, Parsons H, Warneke CL et al (2012) The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer. Oncologist 17:1240–1245. https://doi.org/10.1634/theoncologist.2012-0169 CrossRefPubMedPubMedCentral

19.

Villaseñor A, Ballard-Barbash R, Baumgartner K et al (2012) Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. J Cancer Surviv 6:398–406CrossRefPubMedPubMedCentral

20.

Wong AL, Seng KY, Ong EM et al (2014) Body fat composition impacts the hematologic toxicities and pharmacokinetics of doxorubicin in Asian breast cancer patients. Breast Cancer Res Treat 144:143–152. https://doi.org/10.1007/s10549-014-2843-8 CrossRefPubMed

21.

Iwase T, Sangai T, Nagashima T et al (2016) Impact of body fat distribution on neoadjuvant chemotherapy outcomes in advanced breast cancer patients. Cancer Med 5:41–48. https://doi.org/10.1002/cam4.571 CrossRefPubMed

22.

Antoun S, Bayar A, Ileana E et al (2015) High subcutaneous adipose tissue predicts the prognosis in metastatic castration-resistant prostate cancer patients in post chemotherapy setting. Eur J Cancer Oxf Engl 51:2570–2577. https://doi.org/10.1016/j.ejca.2015.07.042 CrossRef

23.

Cutuli B, Giard-Lefevre S, Antoine M et al (2012) Cancer du sein infiltrant non métastatique - questions d’actualités (synthèse) 82. www.e-cancer.fr/content/download/95914/1021156/file/RECOSEININFILT12.PDF

24.

Shen W, Punyanitya M, Wang Z et al (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol Bethesda Md 97:2333–2338. https://doi.org/10.1152/japplphysiol.00744.2004

25.

Shachar SS, Deal AM, Weinberg M et al (2016) Skeletal muscle measures as predictors of toxicity, hospitalization, and survival in patients with metastatic breast cancer receiving taxane based chemotherapy. Clin Cancer Res Clincanres. https://doi.org/10.1158/1078-0432.CCR-16-0940

26.

Guiu B, Petit JM, Bonnetain F et al (2010) Visceral fat area is an independent predictive biomarker of outcome after first-line bevacizumab-based treatment in metastatic colorectal cancer. Gut 59:341–347. https://doi.org/10.1136/gut.2009.188946 CrossRefPubMed

27.

Moon H-G, Ju Y-T, Jeong C-Y et al (2008) Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol 15:1918–1922CrossRefPubMed

28.

Yip C, Dinkel C, Mahajan A et al (2015) Imaging body composition in cancer patients: visceral obesity, sarcopenia and sarcopenic obesity may impact on clinical outcome. Insights Imaging 6:489–497. https://doi.org/10.1007/s13244-015-0414-0 CrossRefPubMedPubMedCentral

29.

Sottier D, Petit J-M, Guiu S et al (2013) Quantification of the visceral and subcutaneous fat by computed tomography: interobserver correlation of a single slice technique. Diagn Interv Imaging 94:879–884CrossRefPubMed

30.

Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis report of the European working group on sarcopenia in older people. Age Ageing 39:412–423. https://doi.org/10.1093/ageing/afq034

31.

Fielding R, Kirn D, Koochek A et al (2016) PT02.5: impact of a structured physical activity program and nutritional supplementation on regional body composition: results from the Vitality, Independence, and Vigor in the Elderly 2 Study (VIVE2). Clin Nutr 35:S25. https://doi.org/10.1016/S0261-5614(16)30294-1 CrossRef

32.

Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50:889–896CrossRefPubMed

33.

van Dijk DPJ, Bakens MJAM, Coolsen MME et al (2016) Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer. J Cachexia Sarcopenia Muscle. https://doi.org/10.1002/jcsm.12155

34.

Kim TY, Kim MY, Sohn JH et al (2014) Sarcopenia as a useful predictor for long-term mortality in cirrhotic patients with ascites. J Korean Med Sci 29:1253–1259. https://doi.org/10.3346/jkms.2014.29.9.1253 CrossRefPubMedPubMedCentral

35.

Matsuzawa Y (2002) New criteria for “obesity disease” in Japan: the Examination Committee of Criteria for “Obesity Disease” in Japan, Japan Society for the Study of Obesity. Circ J Off J Jpn Circ Soc 66:987–992

36.

Xiao J, Mazurak VC, Olobatuyi TA et al (2016) Visceral adiposity and cancer survival: a review of imaging studies. Eur J Cancer Care (Engl). https://doi.org/10.1111/ecc.12611

Title: Impact of body composition on outcome in patients with early breast cancer
Authors: Elise Deluche
Sophie Leobon
Jean Claude Desport
Laurence Venat-Bouvet
Julie Usseglio
Nicole Tubiana-Mathieu
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 3/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-3902-6

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Mental disorder screening on cancer patients before and after radiotherapy and at the 1-month follow-up

Defibrotide for the treatment of sinusoidal obstruction syndrome: evaluation of response to therapy and patient outcomes

Symptom experience of multiple myeloma (syMMex) patients treated with autologous stem cell transplantation following high-dose melphalan: a descriptive longitudinal study

Comparison of quality of life between 2-year and 3-or-more-year administration of leuprorelin acetate every-3-months depot in combination with tamoxifen as adjuvant endocrine treatment in premenopausal patients with endocrine-responsive breast cancer: a randomized controlled trial

Oncologists’ responses to patient and caregiver negative emotions and patient perception of quality of communication: results from a multi-ethnic Asian setting

Accessing support before or after a parent dies from cancer and young people’s current wellbeing

Keynote webinar | Spotlight on antibody–drug conjugates in cancer