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. 2022 Mar 26;22(1):327.
doi: 10.1186/s12885-022-09443-1.

Skeletal muscle loss during neoadjuvant chemotherapy predicts poor prognosis in patients with breast cancer

Masatsugu Amitani  1 , Takaaki Oba  2 , Nami Kiyosawa  1 , Hiroki Morikawa  1 , Tatsunori Chino  1 , Ai Soma  1 , Tadafumi Shimizu  1 , Koichi Ohno  1 , Mayu Ono  1 , Tokiko Ito  1 , Toshiharu Kanai  1 , Kazuma Maeno  1 , Ken-Ichi Ito  1
Affiliations

Skeletal muscle loss during neoadjuvant chemotherapy predicts poor prognosis in patients with breast cancer

Masatsugu Amitani et al. BMC Cancer. .

Abstract

Background: The skeletal muscle index (SMI), which is calculated as the ratio of skeletal muscle area at the third lumbar vertebral level divided by height squared, has been considered a prognostic factor in patients with breast cancer. However, the prognostic impact of changes in SMI during treatment remains unclear. This study aimed to evaluate the influence of SMI changes in patients with breast cancer undergoing neoadjuvant chemotherapy (NAC).

Methods: We reviewed patients with breast cancer who underwent NAC and subsequent surgery for breast cancer between 2010 and 2017. The rate of SMI change during NAC was calculated, and the association between SMI changes and prognosis was retrospectively analyzed.

Results: In total, 141 patients were evaluated. 48 (34.0%), 53 (37.6%), and 40 (28.4%) patients exhibited increased (≥ 3%), maintained (- 3% <, < 3%), and decreased (- 3% ≥) SMI during NAC, respectively. The decreased SMI group showed significantly poorer disease-free survival than the maintained and increased SMI groups (hazard ratio [HR] 8.29, p < 0.001 for the decreased vs. increased SMI groups; HR 3.49, p < 0.001 for the decreased vs. maintained SMI groups). Moreover, decreased SMI was an independent risk factor for disease-free survival in multivariate analysis (HR 3.68, p < 0.01).

Conclusions: Skeletal muscle loss during NAC predicts poor prognosis. Our results underscore the importance of monitoring and maintaining skeletal muscle mass during NAC.

Keywords: Breast cancer; Disease-free survival; Neoadjuvant chemotherapy; Skeletal muscle index.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percent Change in SMI during NAC of individual patient. Increased was defined as more than 3% increase, maintained as within − 3 to 3% change, and decreased as more than 3% decrease, respectively. Circle indicates the patient who developed recurrence. SMI: Skeletal muscle index, NAC: Neoadjuvant chemotherapy
Fig. 2
Fig. 2
Kaplan–Meier curves for DFS (left) and OS (right) according to changes in SMI (increased, maintained, and decreased). DFS, HR 8.29; 95%CI 3.63–18.9; p < 0.001 for decreased vs. increased, HR 3.49; 95%CI 1.65–7.36; p < 0.001 decreased vs. maintained, HR 2.30; 95%CI 0.77–6.84; p = 0.15 maintained vs. increased. OS, HR 19.8; 95%CI 6.43–60.6; p < 0.001 for decreased vs. increased, HR 3.41; 95%CI 1.29–8.95; p = 0.013 decreased vs. maintained, HR 4.98; 95%CI 0.99–24.5; p = 0.11, maintained vs. increased). DFS: Disease-free survival, OS: Overall survival, SMI: Skeletal muscle index, NAC: Neoadjuvant chemotherapy, HR: Hazard ratio, CI: Confidence interval
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