低骨骼肌放射密度可预测晚期乳腺癌患者对CDK4/6抑制剂联合芳香化酶抑制剂的反应。
Low Skeletal Muscle Radiodensity Predicts Response to CDK4/6 Inhibitors Plus Aromatase Inhibitors in Advanced Breast Cancer.
作者信息
Kim Hyunwook, Baek Seungjin, Han Sookyeong, Kim Gun Min, Sohn Joohyuk, Rhee Yumie, Hong Namki, Kim Min Hwan
机构信息
Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
出版信息
J Cachexia Sarcopenia Muscle. 2025 Feb;16(1):e13666. doi: 10.1002/jcsm.13666. Epub 2024 Dec 17.
BACKGROUND
Recent evidence indicates that a dysregulated host metabolism influences treatment outcomes in patients with breast cancer. We investigated the association of computed tomography (CT)-derived body composition indices with therapeutic responses in patients with hormone receptor-positive, HER2-negative advanced breast cancer (ABC) on endocrine plus CDK4/6 inhibitor (CDK4/6i) treatment.
METHODS
The study involved a retrospective cohort of patients with ABC at the Yonsei Cancer Center who received CDK4/6i and aromatase inhibitors as first-line therapy between January 2017 and October 2020. Body composition parameters were estimated from the non-enhanced CT images of the third lumbar spine by commercialized deep learning software. Patients with low skeletal muscle radiodensity (SMD) were defined as patients with SMD of low tertile (≤ 28.7 Hounsfield Units). The primary outcome was progression-free survival (PFS).
RESULTS
Among the 247 female participants (median age, 53 years; mean body mass index [BMI], 23.7 kg/m), 45.7% had disease progression or death during a median follow-up of 36.4 months. After adjusting for age and visceral metastasis, SMD was the only independent predictor among body composition parameters for worse PFS (adjusted hazard ratio [HR] = 1.20 per standard deviation decrement, 95% CI: 1.01-1.42, p = 0.041), whereas BMI, muscle area, and fat area were not. Participants with low SMD had a higher risk of progression than those without (PFS, 27.2 vs. 51.1 months, p = 0.009; adjusted HR 1.84, 95% CI: 1.22-2.76, p = 0.003). Strong associations between low SMD and poor PFS were observed in groups with pre-menopause status (HR, 3.04 vs. 1.19 in post-menopause; 95% CI: 1.54-5.99, p for interaction < 0.05) and without visceral metastases (HR, 2.95 vs. 1.19 in with visceral metastases; 95% CI: 1.59-5.49, p for interaction < 0.05).
CONCLUSIONS
CT-defined low SMD predicts poor treatment outcomes in patients with ABC undergoing first-line treatment with aromatase inhibitors and CDK4/6i.
背景
近期证据表明，宿主代谢失调会影响乳腺癌患者的治疗结果。我们研究了计算机断层扫描（CT）得出的身体成分指数与激素受体阳性、人表皮生长因子受体2阴性晚期乳腺癌（ABC）患者接受内分泌加细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6i）治疗时治疗反应之间的关联。
方法
该研究纳入了延世癌症中心的ABC患者回顾性队列，这些患者在2017年1月至2020年10月期间接受CDK4/6i和芳香化酶抑制剂作为一线治疗。通过商业化深度学习软件从第三腰椎的非增强CT图像估计身体成分参数。骨骼肌放射密度（SMD）低的患者定义为SMD处于低三分位数（≤28.7亨氏单位）的患者。主要结局是无进展生存期（PFS）。
结果
在247名女性参与者中（中位年龄53岁；平均体重指数[BMI]为23.7kg/m²），在中位随访36.4个月期间，45.7%的患者出现疾病进展或死亡。在调整年龄和内脏转移因素后，SMD是身体成分参数中PFS较差的唯一独立预测因素（调整后风险比[HR]为每标准差下降1.20，95%置信区间：1.01-1.42，p=0.041），而BMI、肌肉面积和脂肪面积则不是。SMD低的参与者比SMD不低的参与者进展风险更高（PFS分别为27.2个月和51.1个月，p=0.009；调整后HR为1.84，95%置信区间：1.22-2.76，p=0.003）。在绝经前状态组（HR为3.04，绝经后为1.19；95%置信区间：1.54-5.99，交互作用p<0.05）和无内脏转移组（HR为2.95，有内脏转移组为1.19；95%置信区间：1.59-5.49，交互作用p<0.05）中观察到SMD低与PFS差之间存在强关联。
结论
CT定义的低SMD可预测接受芳香化酶抑制剂和CDK4/6i一线治疗的ABC患者治疗效果不佳。
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