Muscle composition and outcomes in patients with breast cancer: meta-analysis and systematic review
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Breast cancer is the most common cancer and leading cause of cancer death in women. Body composition parameters, especially those related to muscle, have become a growing focus of cancer research. In this review, we summarize the literature on breast cancer and muscle parameters as well as combine their outcomes for overall survival (OS), time to tumor progression (TTP), and chemotherapy toxicity in a meta-analysis.
A systematic search of the literature for randomized controlled trials and observational studies was conducted on MEDLINE, Cochrane CENTRAL, and EMBASE through May 1, 2019. Two reviewers independently searched and selected. Meta-analysis was conducted using a random-effects model. The risk of bias was evaluated using the Newcastle–Ottawa quality assessment for cohorts and GRADE summary of findings tool from Cochrane.
A total of 754 articles were screened from which 6 articles and one abstract were selected. Using skeletal muscle index (SMI), patients classified as sarcopenic had a 68% greater mortality risk compared to non-sarcopenic patients (HR 1.68 95% CI 1.09–2.59, 5 studies) (p = .02) (i2 = 70%). Low muscle density was not predictive of OS (HR 1.44 95% CI 0.77–2.68, 2 studies) (p = .25) (i2 = 87%). Patients with sarcopenia (56%) had more grade 3–5 toxicity compared to non-sarcopenic (25%) (RR 2.17 95% CI 1.4–3.34, 3 studies) (p = .0005) (i2 = 0%). TTP was nearly 71 days longer in advanced/metastatic patients classified as non-sarcopenic compared to patients with sarcopenia (MD − 70.75 95% CI − 122.32 to − 19.18) (p = .007) (i2 = 0%).
Our synthesis of the literature shows that patients with sarcopenia have more severe chemotherapy toxicity as well as shorter OS and TTP, and that low muscle density is prognostic of OS for women with metastatic breast cancer. Our findings suggest that in clinical practice, body composition assessment is valuable as a prognostic parameter in breast cancer.
KeywordsBreast cancer Sarcopenia Myosteatosis Muscle measures
Skeletal muscle index
Skeletal muscle density
Skeletal muscle gauge
Visceral adipose tissue
Subcutaneous adipose tissue
Magnetic resonance imaging
Dual X-ray absorptiometry
Bioelectrical impedance analysis
We thank for the help and guidance on our search from the University of North Carolina Health Sciences Library.
Compliance with ethical standards
Conflict of interest
The authors declare they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This study did not entail direct contact with humans and therefore did not entail obtaining informed consent.
- 1.WHO cancer data (2018). https://www.who.int/news-room/fact-sheets/detail/cancer
- 13.Williams GR, Deal AM, Muss HB et al (2017) Skeletal muscle measures and physical function in older adults with cancer: sarcopenia or myopenia? Oncotarget 8:33658–33665Google Scholar
- 18.Centre for Reviews and Dissemination (CRD): PROSPERO: internation prospective register for systematic reviews, University of York, UK, 2019Google Scholar
- 48.Feliciano E.C. LV, Chen W, Prado C., Shachar SS, Alexeeff S, Caan BJ: adiposity, muscle mass and delays and dose reduction on adjuvant taxane based chemotherapy for breast cancer. AACR2019 abstract:3284, 2019Google Scholar
- 49.Banerji MA, Faridi N, Atluri R et al (1999) Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab 84:137–144Google Scholar