Cheng En, Caan Bette J, Chen Wendy Y, Prado Carla M, Cespedes Feliciano Elizabeth M
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States; Cancer Epidemiology, Prevention and Control Program, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, United States; Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
Clin Nutr. 2024 Apr;43(4):981-987. doi: 10.1016/j.clnu.2024.03.001. Epub 2024 Mar 6.
BACKGROUND & AIMS: Measurements (amount, distribution, and radiodensity) of muscle and adipose tissue were reported to be individually associated with overall survival in patients with breast cancer. However, they were not typically combined to develop an overall risk score, which can identify patients at high risk of death and prioritize patients in need of dietary and lifestyle interventions. Thus, we aimed to develop a novel composite body composition risk score (B-Score).
We included 3105 patients with stage II or III breast cancer at Kaiser Permanente Northern California and Dana Farber Cancer Institute. From CT scans at diagnosis, we assessed areas and radiodensity of muscle and adipose tissue at the third lumber vertebrae. We considered skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI) and SAT radiodensity as they were independent prognostic factors for overall survival. Each measurement was dichotomized using optimal stratification, with low SMI (<40.1 cm/m), high SATI (≥75.7 cm/m), and high SAT radiodensity (≥-97.2HU) considered risk factors. We calculated B-Score as the sum of these factors and estimated its association with overall survival using Cox proportional hazards regression with adjustment for clinicopathologic factors.
Mean (standard deviation) age was 53.9 (11.8) years, 70.3% were Non-Hispanic White, and 60.5% were stage II. Most patients (60.6%) had only one body composition risk factor (B-Score = 1). Compared to those with no risk factors (B-Score = 0), the risk of death increased with more body composition risk factors: the adjusted hazard ratios were 1.10 (95% CI: 0.85, 1.42), 1.47 (95% CI: 1.12, 1.92), and 2.11 (95% CI: 1.26, 3.53) for B-Scores of 1, 2, and 3, respectively (P < 0.001).
More unfavorable body composition characteristics were associated with increased risks of overall mortality in a dose-response manner. Considering body composition measurements together as a composite score (B-Score) may improve risk stratification and inform dietary and lifestyle interventions following breast cancer diagnosis.
据报道，肌肉和脂肪组织的测量指标（数量、分布及放射密度）分别与乳腺癌患者的总生存期相关。然而，这些指标通常未被综合起来构建一个整体风险评分，该评分能够识别死亡风险高的患者，并对需要饮食和生活方式干预的患者进行优先排序。因此，我们旨在开发一种新的综合身体成分风险评分（B评分）。
我们纳入了北加利福尼亚凯撒医疗集团和达纳-法伯癌症研究所的3105例II期或III期乳腺癌患者。根据诊断时的CT扫描，我们评估了第三腰椎水平的肌肉和脂肪组织面积及放射密度。我们将骨骼肌指数（SMI）、皮下脂肪组织指数（SATI）和SAT放射密度视为总生存期的独立预后因素。每项测量指标通过最优分层进行二分法划分，低SMI（<40.1cm/m）、高SATI（≥75.7cm/m）和高SAT放射密度（≥-97.2HU）被视为风险因素。我们将这些因素的总和计算为B评分，并使用Cox比例风险回归模型在调整临床病理因素后估计其与总生存期的关联。
平均（标准差）年龄为53.9（11.8）岁，70.3%为非西班牙裔白人，60.5%为II期患者。大多数患者（60.6%）仅有一个身体成分风险因素（B评分为1）。与无风险因素（B评分为0）的患者相比，身体成分风险因素越多，死亡风险越高：B评分为1、2和3时，调整后的风险比分别为1.10（95%CI：0.85，1.42）、1.47（95%CI：1.12，1.92）和2.11（95%CI：1.26，3.53）（P<0.001）。
更不利的身体成分特征与总死亡率风险的增加呈剂量反应关系。将身体成分测量指标综合为一个综合评分（B评分）可能会改善风险分层，并为乳腺癌诊断后的饮食和生活方式干预提供依据。
