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

Elise Deluche, Sophie Leobon, Jean Claude Desport, Laurence Venat-Bouvet, Julie Usseglio & Nicole Tubiana-Mathieu. Support Care Cancer (2018) 26:861–868

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

Elise Deluche, Sophie Leobon, Jean Claude Desport,  Laurence Venat-Bouvet, Julie Usseglio & Nicole Tubiana-Mathieu. Support Care Cancer (2018) 26:861–868

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 are as (IMAT), obtained by computed tomography (CT), were assessed.

Methods Atotalof119femalepatientswhohadbreastcancer 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 41.0cm2/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.

Main findings

  • BMI is insufficient on its own. For example, sarcopenic obesity refers to obese cancer patients who lose muscle mass but for whom the weight loss may be masked by excess fat mass if BMI is considered on its own.
  • Body composition is an important feature because it affects the efficacy and toxicity of chemotherapy in different cancers and is associated with patient outcomes. In breast cancer, some studies have analysed the association between body composition and outcomes or toxicities in various situations.
  • Maintaining physical exercise has positive effects and decreases sarcopenia especially in elderly patients. The fight against sarcopenia thus requires an effective screening but also by the implementation of physical activity.