<p>Predictive Role Of Body Composition Parameters In Operable Breast Cancer Patients Treated With Neoadjuvant Chemotherapy</p>

Abstract

Background: Fat tissue is strongly involved in BC tumorigenesis inducing insulin resistance, chronic inflammation and hormonal changes. Computed tomography (CT) imaging instead of body mass index (BMI) gives a reliable measure of skeletal muscle mass and body fat distribution. The impact of body composition parameters (BCPs) on chemosensitivity is still debated. We examined the associations between BCPs and tumor response to neoadjuvant chemotherapy (NC) in patients treated for operable breast cancer (BC). Methods: A retrospective review of BC patients treated with NC in Modena Cancer Center between 2005 and 2017 was performed. BCPs, such as subcutaneous fat area (SFA), visceral fat area (VFA), lumbar skeletal muscle index (LSMI) and liver-to-spleen (L/S) ratio were calculated by Advance workstation (General Electric), software ADW server 3.2 or 4.7. BMI and BCPs were correlated with pathological complete response (pCR) and survival outcomes. Results: 407 patients were included in the study: 55% with BMI < 25 and 45% with BMI ≥ 25. 137 of them had pre-treatment CT scan imagines. Overweight was significantly associated with postmenopausal status and older age. Hormonal receptor positive BC was more frequent in overweight patients (p<0.05). Postmenopausal women had higher VFA, fatty liver disease and obesity compared to premenopausal patients. No association between BMI classes and tumor response was detected. High VFA and liver steatosis were negative predictive factors for pCR (pCR rate: 36% normal VFA vs 20% high VFA, p= 0.048; no steatosis 32% vs steatosis 13%, p=0.056). Neither BMI classes nor BCPs significantly influenced overall survival and relapse-free survival. Conclusion: Visceral adiposity as well as steatosis were closely involved in chemosensitivity in BC patients treated with NC. Their measures from clinically acquired CT scans provide significant predictive information that outperform BMI value. More research is required to evaluate the relationship among adiposity site and survival outcomes.

The Prognostic Impact of Body Composition for Locally Advanced Breast Cancer Patients Who Received Neoadjuvant Chemotherapy

“…Our previous study showed that increased amount and lower quality of VAT was associated with shorter distant disease-free survival via increasing insulin resistance [ 9 ]. Many other preclinical and clinical studies have reported a positive relationship between increased VAT, poor NACT outcome [ 18 ], and shorter survival outcome [ 9 , 10 ]; however, recent studies have indicated that deep abdominal SAT (daSAT)—defined as adipose tissue at the deepest layer of abdominal SAT—is also metabolically active and has a similar metabolic function to that of VAT. A clinical study showed that the depth of daSAT was a strong predictor of insulin resistance [ 19 ], as well as increased expression of pro-inflammatory, lipogenic, and lipolytic genes [ 20 ].…”

Comparison between body composition parameters and response to neoadjuvant chemotherapy by using pre-treatment PET CT in locally advanced breast cancer

“…In this study, we investigated the relationship between SAT, VAT, MT and chemotherapy response rather than investigating the relationship between the BMI and chemotherapy response. Although there are many studies comparing these parameters with patient prognosis, a few studies investigated the response to chemotherapy with some of these parameters [ 15 , 16 , 25 ]. Although Iwase et al found that high VAT was associated with poor NAC outcomes in breast cancer patients especially in postmenopausal patients, they could not find any association between body composition parameters and pCR [ 25 ].…”

“…Although our patient numbers are similar, this difference may be due to different chemotherapy regimens and different distribution of patients among different receptor subtypes. Omarini et al published a recent study, which suggested a negative predictive role of visceral fat in tumor response to NAC [ 16 ]. VAT seemed to be more biologically active and with more procancerous activity than SAT.…”

“…To our knowledge, only few studies have investigated the association between the distribution of body fat and muscle tissue and response to NAC [ 15 , 16 ].…”

The Prognostic Role of Early Skeletal Muscle Mass Depletion in Multimodality Management of Patients with Advanced Gastric Cancer Treated with First Line Chemotherapy: A Pilot Experience from Modena Cancer Center

“…An adequate evaluation of patients’ nutritional status in metastatic setting cannot ignore the assessment of skeletal muscle mass and skeletal muscle density using computed tomography scan. Previous studies in various types of cancer highlighted the strong association between survival, treatment toxicities and the amount of muscle and adipose tissue at diagnosis such as its modification during chemotherapy [ 13 , 14 , 15 , 16 ].…”