Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2024 Jan 1;118(1):94-103. doi: 10.1016/j.ijrobp.2023.07.018. Epub 2023 Jul 26.
Sarcopenia, an age-related decline in muscle mass and physical function, is associated with increased toxicity and worse outcomes in women with breast cancer (BC). Sarcopenia may contribute to toxicity-related early discontinuation of adjuvant endocrine therapy (aET) in women with hormone receptor-positive (HR+) BC but remains poorly characterized.
This multicenter, retrospective cohort study included consecutive women with stage 0-II HR+ BC who received breast conserving therapy (lumpectomy and radiation therapy) and aET from 2011 to 2017 with a 5-year follow-up. Skeletal muscle index (SMI, cm/m) was analyzed using a deep learning model on routine cross-sectional radiation simulation imaging; sarcopenia was dichotomized according to previously validated reports. The primary endpoint was toxicity-related aET discontinuation; logistic regression analysis evaluated associations between SMI/sarcopenia and aET discontinuation. Cox regression analysis evaluated associations with time to aET toxicity, ipsilateral breast tumor recurrence (IBTR), and disease-free survival (DFS).
A total of 305 women (median follow-up, 89 months) were included with a median age of 67 years and early-stage BC (12% stage 0, 65% stage I). A total of 60 (20%) women experienced toxicity-related aET discontinuation. Sarcopenia was associated with toxicity-related early discontinuation of aET (odds ratio, 2.18; P = .036) and shorter time to aET toxicity (hazard ratio [HR], 1.62; P = .031). SMI or sarcopenia were not independently associated with IBTR or DFS; toxicity-related aET discontinuation was associated with worse IBTR (HR, 9.47; P = .002) and worse DFS (HR, 4.53; P = .001).
Among women with early-stage HR+ BC who receive adjuvant radiation therapy and hormone therapy, sarcopenia is associated with toxicity-related early discontinuation of aET. Further studies should validate these findings in women who did not receive adjuvant radiation therapy. These high-risk patients may be candidates for aggressive symptom management and/or alternative treatment strategies to improve outcomes.
肌肉减少症是一种与年龄相关的肌肉质量和身体功能下降，与乳腺癌（BC）女性的毒性增加和预后恶化相关。肌肉减少症可能导致激素受体阳性（HR+）BC 女性辅助内分泌治疗（aET）相关毒性的早期停药，但仍描述不足。
这项多中心、回顾性队列研究纳入了 2011 年至 2017 年期间接受保乳治疗（乳房切除术和放射治疗）和 aET 的连续 HR+BC 期 0-II 期女性患者，随访时间为 5 年。使用深度学习模型对常规横断面放射模拟成像进行骨骼肌指数（SMI，cm/m）分析；根据先前验证的报告将肌肉减少症分为二分类。主要终点是与毒性相关的 aET 停药；逻辑回归分析评估了 SMI/肌肉减少症与 aET 停药的关系。Cox 回归分析评估了与 aET 毒性、同侧乳房肿瘤复发（IBTR）和无病生存（DFS）时间的关系。
共纳入 305 例女性（中位随访时间 89 个月），中位年龄 67 岁，早期 BC（0 期 12%，I 期 65%）。共有 60 例（20%）女性发生与毒性相关的 aET 停药。肌肉减少症与 aET 毒性相关的早期停药相关（优势比，2.18；P=0.036），且 aET 毒性发生时间更短（风险比[HR]，1.62；P=0.031）。SMI 或肌肉减少症与 IBTR 或 DFS 无独立相关性；与毒性相关的 aET 停药与更差的 IBTR（HR，9.47；P=0.002）和更差的 DFS（HR，4.53；P=0.001）相关。
在接受辅助放疗和激素治疗的早期 HR+BC 女性中，肌肉减少症与 aET 毒性相关的早期停药相关。进一步的研究应在未接受辅助放疗的女性中验证这些发现。这些高危患者可能是积极症状管理和/或替代治疗策略的候选者，以改善结局。
