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

Abstract

Our previous study indicated that a high amount of visceral adipose tissue was associated with poor survival outcomes in patients with early breast cancer who received neoadjuvant chemotherapy. However, inconsistency was observed in the prognostic role of body composition in breast cancer treatment outcomes. In the present study, we aimed to validate our previous research by performing a comprehensive body composition analysis in patients with a standardized clinical background. We included 198 patients with stage III breast cancer who underwent neoadjuvant chemotherapy between January 2007 and June 2015. The impact of body composition on pathologic complete response and survival outcomes was determined. Body composition measurements had no significant effect on pathologic complete response. Survival analysis showed a low ratio of total visceral adipose tissue to subcutaneous adipose tissue (V/S ratio ≤ 34) was associated with shorter overall survival. A changepoint method determined that a V/S ratio cutoff of 34 maximized the difference in overall survival. Our study indicated the prognostic effect of body composition measurements in patients with locally advanced breast cancer compared to those with early breast cancer. Further investigation will be needed to clarify the biological mechanism underlying the association of V/S ratio with prognosis in locally advanced breast cancer.

Association of body composition and survival in patients with locally advanced breast cancer: a historical cohort study

“…These could alter the measurement of muscle parameters. In addition, we found that overweight and obesity had no impact on the survival of patients with LABC, which aligns with the findings of a previous study (19). BMI may be a factor that roughly represents whole body mass and height.…”

“…Therefore, the effect of low or high subcutaneous fat on the survival of patients with LABC is inconclusive and further study is required. We could not find the effect of muscle composition on survival in patients with LABC, including sarcopenia, muscle radiodensity, and composite muscle, which were consistent with a previous study (19). In contrast, another recent study (20) showed that sarcopenia reduced OS in patients with LABC, but not DFS.…”

“…Patients with a low V/S ratio had a double aHR compared to those with a normal V/S ratio in our study. To date, only one study conducted in the United States assessing survival and V/S volume ratio (19) showed results similar to our study, even though the measurement techniques of visceral and subcutaneous adiposity were not exactly the same. Both studies assessed visceral and subcutaneous adiposity from CT images; however, the previous study (19) measured visceral and subcutaneous adiposity volume from the diaphragmatic top to the umbilical level, but we measured the visceral and subcutaneous adiposity area from CT images at the L3 level.…”

“…These studies showed various effects of body compositions on the survival of patients with LABC depending on study settings and patients' characteristics. A study reported significantly shorter survival in patients with LABC with a low ratio of visceral to subcutaneous adiposity volume; however, it was insignificant for those with sarcopenia (19). In contrast, another study reported significantly reduced OS, but not disease-specific survival, in patients with LABC with sarcopenia (20).…”

“…To date, only three studies have investigated the association between body composition and locally advanced breast cancer (LABC) – a late stage of breast cancer without distance metastasis (11,19,20). These studies showed various effects of body compositions on the survival of patients with LABC depending on study settings and patients’ characteristics.…”