Prognostic value of body composition measures in breast cancer patients treated with chemotherapy

Abstract

Breast cancer remains a significant public health issue, often resulting in severe side effects such as neutropenia, highlighting the need for reliable predictors of clinical outcomes. This study aimed to evaluate the predictive value of body composition measures for mortality, recurrence, and chemotherapy-induced neutropenia in patients with breast cancer following surgery and chemotherapy. We retrospectively analyzed 85 breast cancer patients who underwent surgery and chemotherapy between 2006 and 2016. Body composition was assessed using computed tomography (CT) or positron emission tomography (PET) at diagnosis and three years and five years post-diagnosis. Metrics included skeletal muscle area (SMA), skeletal muscle index (SMI), subcutaneous adipose tissue area (SAT), and visceral adipose tissue area (VAT). Longitudinal analysis revealed a decrease in muscle mass (P < 0.001 for both SMA and SMI) and nonsignificant changes in fat mass (P = 0.449 for SAT and P = 0.798 for VAT). A lower SMI at diagnosis was significantly associated with increased mortality (P = 0.019) and a higher incidence of grade 4 neutropenia (P = 0.008). There was no significant association between SMI at diagnosis and recurrence (P = 0.691). No associations were found between body composition measurements during the follow-up period and the clinical outcomes. Lower skeletal muscle mass at diagnosis is strongly associated with higher mortality and chemotherapy-induced complications in patients with breast cancer, highlighting the potential of readily available imaging techniques as valuable predictors of clinical outcomes.

Keywords: Body composition; Breast cancer; Chemotherapy-induced neutropenia; Mortality; Prognosis; Sarcopenia.

Fig. 1

Flowchart of the study population. Serial imaging refers to a minimum of three APCT or PET scans obtained at the time of initial breast cancer diagnosis, within three years (± 6 months) and five years (± 6 months) after diagnosis. APCT abdominopelvic computed tomography, PET positron emission tomography.

Fig. 2

Measurement of skeletal muscle and fat at the umbilical (L3) level. (A) CT image pre-analysis. (B) CT image post-analysis. The axial section of the CT image is segmented into SMA (red), SAT (blue), and VAT (green). CT computed tomography, SMA skeletal muscle area, SAT subcutaneous adipose tissue area, VAT visceral adipose tissue area.

Fig. 3

OS of patient subgroups by SMI. (A) OS of patients with lower SMI than the cutoff at diagnosis versus others. (B) OS of patients with lower SMI than the cutoff at diagnosis and after 3 years versus others. (C) OS of patients with lower SMI than the cutoff at diagnosis and after 5 years versus others. OS overall survival, SMI skeletal muscle index.