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

Adverse effects of systemic cancer therapy on skeletal muscle: myotoxicity comes out of the closet

“…Despite overall significant muscle loss, this outcome is not inevitable. This is illustrated by waterfall plots of muscle change in patients with different cancers and treatments (breast, head and neck, esophageal) shown by several authors [14,18,26]; also see Fig. 2.…”

“…This serial biopsy approach allowed the investigators to record changes in mitochondrial biogenesis, mitochondrial dynamics and mitophagy [49 ▪▪ ] as well as fatty infiltration [50], specific to a treatment plan that includes anthracycline, cyclophosphamide and taxane. Although muscle mass loss was undetectable by CT when patients received this regimen [12,13 ▪ ,14] (see above), microscopic and biochemical tests reveal important changes.…”

Does neoadjuvant chemotherapy regimen affect sarcopenia status in patients with breast cancer?

“…No previous breast cancer studies in South Korea have specified how much muscle mass was lost during neoadjuvant chemotherapy, but compared to studies performed in other countries, we observed a slightly higher SMI at baseline and a slightly lower SMI after chemotherapy, despite the fact that no metastatic cancer was present in our patients. As decreased SMI after neoadjuvant chemotherapy poses a threat to disease-free survival [25], decreased SMI should be given attention when determining the direction of clinical treatment and evaluating treatment effectiveness.…”

Highlighting the idea of exerkines in the management of cancer patients with cachexia: novel insights and a critical review

“…Epidemiological data show that skeletal muscle wasting is seen in most cancers [ 19 , 20 ]. Skeletal muscles are more affected than other organs during CC [ 21 , 22 ], however our understanding of why skeletal muscle is more affected by CC is incomplete.…”