Günaltılı Murat, Guliyev Murad, Fidan Mehmet Cem, Birsin Zeliha, Çerme Emir, Aliyev Vali, Abbasov Hamza, Cebeci Selin, Jeral Seda, Alan Özkan, Demirci Nebi Serkan, Papila Çiğdem, Şahin Onur Erdem, Bıyıkoğlu Said Erkam, Öztürk Tülin, Papila Berrin
Division of Medical Oncology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey.
Department of Nuclear Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey.
Medicina (Kaunas). 2025 Aug 22;61(9):1508. doi: 10.3390/medicina61091508.
Breast cancer is a leading cause of cancer-related mortality, particularly in aggressive subtypes such as HER2-positive and triple-negative breast cancer (TNBC). Achieving a pathological complete response (pCR) after neoadjuvant therapy is strongly associated with improved survival outcomes in these subgroups, making the prediction of pCR a clinical priority. Sarcopenia, a progressive loss of skeletal muscle mass and strength, is increasingly recognized in cancer patients and has been linked to chemotherapy toxicity and poorer survival. However, its specific impact on pCR in HER2-positive and TNBC patients remains unclear. This study aimed to evaluate the association between radiologically defined sarcopenia, or a low skeletal muscle index (SMI), and pathological response in these subtypes, and to explore its potential as a predictive biomarker. This retrospective study included patients with HER2-positive or TNBC who received neoadjuvant therapy between January 2015 and October 2023. SMI was assessed using pre-treatment positron emission tomography images at the L3 vertebral level, with values < 38.5 cm/m considered as low. Univariate and multivariate logistic regression analyses were performed to identify factors associated with pCR. A total of 85 patients were included, with low SMI present in 35 (41.2%). In univariate analysis, clinical stage and low SMI were associated with pCR. However, in the multivariate model, only low SMI remained an independent predictor. Patients without low SMI had higher odds of achieving pCR (odds ratio [OR] 4.13; 95% confidence interval [CI] 1.55-10.95; = 0.004). Low SMI was also associated with higher rates of treatment-related toxicity (42.9% vs. 20.0%, = 0.023). Pre-treatment low SMI is strongly associated with lower pCR rates in patients with HER2-positive and TNBC undergoing neoadjuvant therapy. These findings underscore the importance of early identification and management of radiologically defined sarcopenia to optimize treatment response and improve clinical outcomes.
乳腺癌是癌症相关死亡的主要原因，尤其是在HER2阳性和三阴性乳腺癌（TNBC）等侵袭性亚型中。新辅助治疗后实现病理完全缓解（pCR）与这些亚组患者生存结果的改善密切相关，因此预测pCR成为临床优先事项。肌肉减少症是骨骼肌质量和力量的逐渐丧失，在癌症患者中越来越受到关注，并且与化疗毒性和较差的生存率有关。然而，其对HER2阳性和TNBC患者pCR的具体影响仍不清楚。本研究旨在评估放射学定义的肌肉减少症或低骨骼肌指数（SMI）与这些亚型病理反应之间的关联，并探讨其作为预测生物标志物的潜力。这项回顾性研究纳入了2015年1月至2023年10月期间接受新辅助治疗的HER2阳性或TNBC患者。使用治疗前L3椎体水平的正电子发射断层扫描图像评估SMI，值<38.5 cm/m被视为低。进行单因素和多因素逻辑回归分析以确定与pCR相关的因素。总共纳入了85例患者，其中35例（41.2%）存在低SMI。在单因素分析中，临床分期和低SMI与pCR相关。然而，在多因素模型中，只有低SMI仍然是独立预测因素。没有低SMI的患者实现pCR的几率更高（优势比[OR] 4.13；95%置信区间[CI] 1.55 - 10.95；P = 0.004）。低SMI还与更高的治疗相关毒性发生率相关（42.9%对20.0%，P = 0.023）。治疗前低SMI与接受新辅助治疗的HER2阳性和TNBC患者较低的pCR率密切相关。这些发现强调了早期识别和管理放射学定义的肌肉减少症以优化治疗反应和改善临床结果的重要性。
