女性乳腺癌患者的身体成分与化疗毒性：系统评价。
Body composition and chemotherapy toxicity among women treated for breast cancer: a systematic review.
机构信息
Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, NW, 2nd Floor, Washington, DC, 20052, USA.
Himmelfarb Health Sciences Library, George Washington University, Washington, DC, USA.
出版信息
J Cancer Surviv. 2024 Aug;18(4):1356-1369. doi: 10.1007/s11764-023-01380-7. Epub 2023 Apr 24.
PURPOSE
Toxicity is a significant problem among women receiving systemic chemotherapy for breast cancer, with up to 60% experiencing hematologic and 14% experiencing non-hematologic toxicity. Chemotherapy is dosed using body surface area, which does not account for heterogeneity in lean body mass (LBM) and adipose tissue (AT). This systematic review, registered with the PROSPERO International Prospective Register of Systematic Reviews (#CRD42021279874), evaluates associations between body composition and chemotherapy-related toxicity during breast cancer treatment.
METHODS
Scientific literature databases (PubMed, Scopus, CINAHL, and CENTRAL) were systematically searched in November 2021 for studies evaluating associations between body composition (assessed using computed tomography or dual x-ray absorptiometry) and chemotherapy-related toxicity among women receiving breast cancer treatment. Eligibility was not limited by year or country of publication. Article screening and data abstraction was conducted using the Covidence Systematic Review Management System. Predetermined criteria were used to evaluate rigor of participant recruitment, representativeness of the population, and use of validated measures of body composition and toxicity.
RESULTS
An inverse association between LBM and toxicity was reported in seven of the eight included studies, although definitions of low LBM differed across studies. Three studies evaluated the association between AT and chemotherapy toxicity with inconsistent findings. Heterogeneity in body composition measures/definitions and treatment regimens precluded the ability to perform meta-analyses.
CONCLUSION
Low LBM appears to be a risk factor for chemotherapy toxicity, but the role of AT is unclear.
IMPLICATIONS FOR CANCER SURVIVORS
Further research that accounts for guideline concordance in chemotherapy prescriptions and the use of supportive care medications is needed.
目的
在接受乳腺癌全身化疗的女性中，毒性是一个严重的问题，多达 60%的人出现血液学毒性，14%的人出现非血液学毒性。化疗的剂量是根据体表面积计算的，而体表面积没有考虑到瘦体重（LBM）和脂肪组织（AT）的异质性。本系统评价在 PROSPERO 国际前瞻性系统评价注册中心（#CRD42021279874）注册，评估了乳腺癌治疗过程中身体成分与化疗相关毒性之间的关联。
方法
2021 年 11 月，我们系统地检索了科学文献数据库（PubMed、Scopus、CINAHL 和 CENTRAL），以评估评估接受乳腺癌治疗的女性身体成分（使用计算机断层扫描或双能 X 线吸收法评估）与化疗相关毒性之间关联的研究。入选标准不受发表年份或国家的限制。使用 Covidence 系统评价管理系统进行文章筛选和数据提取。使用预先确定的标准来评估参与者招募的严谨性、人群的代表性以及身体成分和毒性的验证性测量的使用。
结果
在纳入的八项研究中有七项报告了 LBM 与毒性之间呈负相关，尽管研究中低 LBM 的定义不同。三项研究评估了 AT 与化疗毒性的关联，结果不一致。身体成分测量/定义和治疗方案的异质性使得无法进行荟萃分析。
结论
低 LBM 似乎是化疗毒性的一个危险因素，但 AT 的作用尚不清楚。
对癌症幸存者的影响
需要进一步的研究，以考虑化疗处方的指南一致性和支持性护理药物的使用。
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