术前新辅助化疗中 CT 体成分分析对可手术和局部晚期乳腺癌的预测和预后作用。

Predictive and prognostic effect of computed tomography-derived body composition analysis during neoadjuvant chemotherapy for operable and locally advanced breast cancer.

机构信息

Dietetic Service, Medical Direction, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.

Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.

出版信息

Nutrition. 2023 Jan;105:111858. doi: 10.1016/j.nut.2022.111858. Epub 2022 Oct 1.

DOI:10.1016/j.nut.2022.111858

PMID:36323147

Abstract

OBJECTIVES

Excess adiposity is associated with several factors involved in carcinogenesis and breast cancer progression. Evidence supporting the role of body composition in breast cancer treatment is promising, but still scanty and mainly focused on adjuvant treatment. The aim of this study was to evaluate the changes in body composition during neoadjuvant chemotherapy and its association with pathologic complete response and survival outcome in patients treated for operable/locally advanced breast cancer.

METHODS

A retrospective review of patients with breast cancer treated with neoadjuvant chemotherapy was performed in the Oncology Section of the Department of Medicine, University of Verona between 2014 and 2019. Body composition was evaluated from clinically acquired computed tomography scans at diagnosis and after neoadjuvant chemotherapy. Descriptive statistic was adopted. The associations of body composition measures with pathologic complete response and disease-free survival were analyzed. Kaplan-Meier curves were compared with log-rank analysis.

RESULTS

Data from 93 patients were collected. After neoadjuvant chemotherapy, the adipose compound changed significantly across all body mass index categories. Body composition parameters had no significant effect on pathologic complete response. Survival analysis showed that a high gain of visceral adipose tissue during neoadjuvant chemotherapy was associated with shorter disease-free survival (hazard ratio, 10.2; P = 0.026). In particular, disease-free survival was significantly worse in patients who gained ≥10% of visceral adipose tissue compared with patients who gained <10% of visceral adipose tissue (5-y disease-free survival 71.4 versus 96.3, P = 0.009, respectively).

CONCLUSIONS

Our results indicated that neoadjuvant chemotherapy significantly affects body composition, which seems to have an effect on survival outcome of breast cancer, highlighting the relevance of the body composition assessment when estimating treatment outcomes.

摘要

目的

过多的体脂与致癌和乳腺癌进展相关的多种因素有关。支持身体成分在乳腺癌治疗中作用的证据很有前景，但仍然很少，主要集中在辅助治疗上。本研究旨在评估新辅助化疗期间身体成分的变化及其与可手术/局部晚期乳腺癌患者的病理完全缓解和生存结果的关系。

方法

对 2014 年至 2019 年期间在维罗纳大学医学系肿瘤科接受新辅助化疗的乳腺癌患者进行了回顾性研究。在诊断时和新辅助化疗后，从临床获得的计算机断层扫描中评估身体成分。采用描述性统计。分析了身体成分指标与病理完全缓解和无病生存的关系。采用 Kaplan-Meier 曲线和对数秩检验进行比较。

结果

共收集了 93 例患者的数据。新辅助化疗后，所有身体质量指数类别的脂肪复合物均发生显著变化。身体成分参数对病理完全缓解没有显著影响。生存分析显示，新辅助化疗期间内脏脂肪组织的大量增加与无病生存时间较短相关（危险比，10.2；P=0.026）。特别是，与内脏脂肪组织增加<10%的患者相比，内脏脂肪组织增加≥10%的患者无病生存显著更差（5 年无病生存率分别为 71.4%和 96.3%，P=0.009）。