Association of Muscle and Adiposity Measured by Computed Tomography With Survival in Patients With Non metastatic Breast Cancer
Association of Muscle and Adiposity Measured by Computed Tomography With Survival in Patients With Non metastatic Breast Cancer
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DOI：
10.1001/jamaoncol.2018.0137
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发表时间：
2018-06-01
期刊：
影响因子：
28.4
通讯作者：
Chen, Wendy Y.
中科院分区：
文献类型：
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作者：
Caan, Bette J.;Feliciano, Elizabeth M. Cespedes;Chen, Wendy Y.
重要性：计算机断层扫描（CT）显示的肌肉减少症（低肌肉质量）、肌肉质量差（低肌肉放射密度）和过度肥胖与转移性乳腺癌患者较高的死亡率有关，但与非转移性乳腺癌患者预后的关系尚不清楚。目的：评价诊断时临床获得性CT的所有3种身体成分测量与非转移性乳腺癌总死亡率的关系。设计、环境和参与者：这项观察性研究包括3241名来自北加州凯撒医疗机构和达纳法伯癌症研究所的女性，2000年1月至2013年12月诊断为II期或III期乳腺癌。我们计算了风险比（hr）来评估全因死亡率与肌肉减少症、低肌肉放射密度和总脂肪组织（TAT）之间的关系。模型根据社会人口统计学、肿瘤特征、治疗、身体质量指数（BMI；以体重（公斤）除以身高（米）的平方计算）和其他身体成分测量进行调整。我们还评估了肌肉减少症的交叉分类（是/否）和TAT的三分位数，以及结果。主要结局和指标：总生存时间和全因死亡率。结果：本研究纳入3241名女性的中位（范围）年龄为54（18-80）岁，中位随访时间为6.0年；1086例（34%）患者表现为肌肉减少症，1199例（37%）患者表现为低肌肉放射密度。在非转移性乳腺癌患者中，与没有肌肉减少症的患者相比，肌肉减少症患者的总死亡率更高（HR, 1.41; 95% CI, 1.18-1.69）。TAT最高分位数的患者与最低分位数的患者相比，总死亡率也更高（HR, 1.35; 95% CI, 1.08-1.69）。低放射密度与生存无关。在肌肉减少症和TAT的分析中，肌肉减少症和TAT高的患者死亡率最高（HR, 1.89; 95% CI, 1.30-2.73）；单独的BMI与总体死亡率没有显著相关性，并且不能适当地识别由于其身体组成而存在死亡风险的患者。结论和相关性：肌减少症在非转移性乳腺癌中未被充分认识，并且发生在超过三分之一的新诊断患者中。在非转移性患者中，通过临床获得的CT扫描测量肌肉减少症和肥胖提供了比BMI更重要的预后信息，并将有助于指导干预措施以优化生存结果。
IMPORTANCE: Sarcopenia (low muscle mass), poor muscle quality (low muscle radiodensity), and excess adiposity derived from computed tomography (CT) has been related to higher mortality in patients with metastatic breast cancer, but the association with prognosis in patients with nonmetastatic breast cancer is unknown. OBJECTIVE: To evaluate associations of all 3 body composition measures, derived from clinically acquired CT at diagnosis, with overall mortality in nonmetastatic breast cancer. DESIGN, SETTING, AND PARTICIPANTS: This observational study included 3241 women from Kaiser Permanente of Northern California and Dana Farber Cancer Institute diagnosed from January 2000 to December 2013 with stages II or III breast cancer. We calculated hazard ratios (HRs) to evaluate the associations of all-cause mortality with sarcopenia, low muscle radiodensity, and total adipose tissue (TAT). Models were adjusted for sociodemographics, tumor characteristics, treatment, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and other body composition measures. We also evaluated the cross-classification of categories of sarcopenia (yes/no) and tertiles of TAT, with outcomes. MAIN OUTCOMES AND MEASURES: Overall survival time and all-cause mortality. RESULTS: Median (range) age of 3241 women included in this study was 54 (18-80) years, and median follow-up was 6.0 years; 1086 patients (34%) presented with sarcopenia, and 1199 patients (37%) had low muscle radiodensity. Among patients with nonmetastatic breast cancer, those with sarcopenia showed higher overall mortality (HR, 1.41; 95% CI, 1.18-1.69) compared with those without sarcopenia. Patients in the highest tertile of TAT also showed higher overall mortality (HR, 1.35; 95% CI, 1.08-1.69) compared with those in the lowest tertile. Low radiodensity was not associated with survival. In analyses of sarcopenia and TAT, highest mortality was seen in patients with sarcopenia and high TAT (HR, 1.89; 95% CI, 1.30-2.73); BMI alone was not significantly related to overall mortality and did not appropriately identify patients at risk of death owing to their body composition.CONCLUSIONS AND RELEVANCE: Sarcopenia is underrecognized in nonmetastatic breast cancer and occurs in over one-third of newly diagnosed patients. Measures of both sarcopenia and adiposity from clinically acquired CT scans in nonmetastatic patients provide significant prognostic information that outperform BMI and will help to guide interventions to optimize survival outcomes.