Body Composition, Adherence to Anthracycline and Taxane-Based Chemotherapy, and Survival After Nonmetastatic Breast Cancer
Body Composition, Adherence to Anthracycline and Taxane-Based Chemotherapy, and Survival After Nonmetastatic Breast Cancer
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DOI：
10.1001/jamaoncol.2019.4668
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发表时间：
2020-02-01
期刊：
影响因子：
28.4
通讯作者：
Caan, Bette J.
中科院分区：
文献类型：
--
作者：
Cespedes Feliciano, Elizabeth M.;Chen, Wendy Y.;Caan, Bette J.
这项队列研究评估了乳腺癌患者的身体组成与死亡风险之间的关系，其基础是计划与化疗剂量的比值。重要性尽管大多数化疗剂量与体表面积或体重有关，但身体组成（即肌肉和脂肪组织的数量和分布）被认为与化疗耐受性和依从性有关。目的评估身体成分是否与蒽环类和紫杉烷类化疗的相对剂量强度（RDI）或血液毒性效应相关，以及较低的RDI是否介导肥胖与死亡率的相关性。设计、设置和参与者在Kaiser Permanente北方加州进行了一项前瞻性收集电子病历数据的观察性队列研究，这是一个综合医疗保健提供系统内的多中心社区肿瘤学设置。参与者包括2005年1月1日至2013年12月31日期间诊断的1395例非转移性乳腺癌患者，并接受蒽环类和紫杉烷类化疗。数据分析于2019年2月25日至9月4日进行。在诊断时，通过临床获得的计算机断层扫描评价肌内、内脏和皮下脂肪以及骨骼肌。主要结果和测量主要结果是低RDI（
This cohort study evaluates the association between body composition and the risk of death based on the ratio of planned vs administered dose of chemotherapy in women with breast cancer.Importance Although most chemotherapies are dosed on body surface area or weight, body composition (ie, the amount and distribution of muscle and adipose tissues) is thought to be associated with chemotherapy tolerance and adherence. Objectives To evaluate whether body composition is associated with relative dose intensity (RDI) on anthracycline and taxane-based chemotherapy or hematologic toxic effects and whether lower RDI mediates the association of adiposity with mortality. Design, Setting, and Participants An observational cohort study with prospectively collected electronic medical record data was conducted at Kaiser Permanente Northern California, a multicenter, community oncology setting within an integrated health care delivery system. Participants included 1395 patients with nonmetastatic breast cancer diagnosed between January 1, 2005, and December 31, 2013, and treated with anthracycline and taxane-based chemotherapy. Data analysis was performed between February 25 and September 4, 2019. Exposures Intramuscular, visceral, and subcutaneous adiposity as well as skeletal muscle were evaluated from clinically acquired computed tomographic scans at diagnosis. Main Outcomes and Measures The primary outcome was low RDI (