Division of Human Nutrition and Health, Wageningen University & Research, PO Box 17, 6700 AA, Wageningen, The Netherlands.
Amphia Ziekenhuis, Breda, The Netherlands.
Breast Cancer Res Treat. 2019 Jan;173(2):475-481. doi: 10.1007/s10549-018-5014-5. Epub 2018 Oct 23.
Initial dose of chemotherapy is planned based on body surface area, which does not take body composition into account. We studied the association between fat mass (kg and relative to total body weight) as well as lean mass (kg and relative to total body weight) and toxicity-induced modifications of treatment in breast cancer patients receiving chemotherapy.
In an observational study among 172 breast cancer patients (stage I-IIIB) in the Netherlands, we assessed body composition using dual-energy X-ray scans. Information on toxicity-induced modifications of treatment, defined as dose reductions, cycle delays, regimen switches, or premature termination of chemotherapy, was abstracted from medical records. Adjusted hazard ratios and 95% confidence intervals (95% CI) were calculated to assess associations between body composition and the risk of toxicity-induced modifications of treatment.
In total, 95 out of 172 (55%) patients experienced toxicity-induced modifications of treatment. Higher absolute and relative fat mass were associated with higher risk of these modifications (HR 1.14 per 5 kg; 95% CI 1.04-1.25 and HR 1.21 per 5%; 95% CI 1.05-1.38, respectively). A higher relative lean mass was associated with a lower risk of modifications (HR 0.83 per 5%; 95% CI 0.72-0.96). There was no association between absolute lean mass and risk of toxicity-induced modifications of treatment.
A higher absolute and a higher relative fat mass was associated with an increased risk of toxicity-induced modifications of treatment. Absolute lean mass was not associated with risk of these treatment modifications, while higher relative lean mass associated with lower risk of modifications. These data suggest that total fat mass importantly determines the risk of toxicities during chemotherapy in breast cancer patients.
化疗的初始剂量是根据体表面积来计划的，而没有考虑到身体成分。我们研究了脂肪量（kg 和相对于总体重的比例）以及瘦体量（kg 和相对于总体重的比例）与接受化疗的乳腺癌患者治疗毒性改变之间的关系。
在荷兰的一项针对 172 例乳腺癌患者（I 期至 IIIB 期）的观察性研究中，我们使用双能 X 射线扫描来评估身体成分。从病历中提取关于治疗毒性改变的信息，定义为剂量减少、周期延迟、方案改变或提前终止化疗。计算调整后的危险比和 95%置信区间（95%CI）来评估身体成分与治疗毒性改变风险之间的关联。
共有 172 例患者中的 95 例（55%）经历了治疗毒性改变。绝对和相对脂肪量越高，这些改变的风险越高（每增加 5kg 分别为 HR 1.14，95%CI 1.04-1.25 和 HR 1.21，95%CI 1.05-1.38）。相对瘦体量较高与修改的风险较低相关（每增加 5%分别为 HR 0.83，95%CI 0.72-0.96）。绝对瘦体量与治疗毒性改变的风险之间没有关联。
较高的绝对和相对脂肪量与治疗毒性改变的风险增加相关。绝对瘦体量与这些治疗改变的风险无关，而相对瘦体量与改变的风险较低相关。这些数据表明，在乳腺癌患者的化疗期间，总脂肪量重要地决定了毒性的风险。
