Body composition metrics as predictors of adverse events are a growing area of interest in oncology research. One barrier to the use of these metrics in clinical practice is the lack of standardized cut points for identifying patients with at-risk body composition profiles. We examined the association of chemotherapy adverse events with several body composition measures, using alternative cut points from published studies.
This is a retrospective study of women diagnosed with early breast cancer (EBC). Axial computerized tomography (CT) images from lumbar L3 segments were analyzed for the following body composition measures: myosteatosis (low Skeletal Muscle Density/SMD), sarcopenia (low Skeletal Muscle Index/SMI), and high Visceral Adipose Tissue (VAT). Adverse events during chemotherapy were dose reduction, early treatment discontinuation, and hospitalization. Log-binomial modeling was used to evaluate associations between body composition measures at different cut points with adverse events, adjusting for age, race, Body Mass Index/BMI, and comorbidities. Relative risks were reported as the measure of association.
In a sample of 338 women, mean age was 51, 14% were age 65 or older, 32% were non-white, 40% had obesity (/BMI ≥ 30 kg/m2), and mean number of comorbidities was 1.56. In multivariable analysis (MV), all three SMD cut points for myosteatosis had significant associations with total number of adverse events, as well as different cut points having significant associations with either dose reduction, early treatment discontinuation or hospitalization. SMI and VAT were not significant in the MV analysis; however, in some models, age and total comorbidities were significant for adverse events.
Among CT-derived measures of body composition, myosteatosis determined at any of three SMD cut points was associated with total and individual adverse events during chemotherapy for early breast cancer.
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We greatly appreciate the active support of oncology clinicians and their research staff at multiple sites and, most importantly, the breast cancer patients participating in our study. We thank Tucker Brenizer, Shanah R. Kirk, and Amy Garrett for their commitment to study implementation best practices.
This study was supported by the Breast Cancer Research Foundation (New York), UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund, and Kay Yow Fund (Raleigh North Carolina).
Conflict of interest
Gabriel FP Aleixo, Allison M Deal, Kirsten A. Nyrop, Hyman B Muss, Yi Tang Chen, Grant R Williams, Hyeon Yu, and Shlomit S Shachar declare they have no conflict 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 article does not contain any animals performed by any of the authors. Informed consent was obtained from all individuals participants in this study and approved by the IRB of the University of North Carolina at Chapel Hill.
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Aleixo, G.F.P., Shachar, S.S., Deal, A.M. et al. The association of body composition parameters and adverse events in women receiving chemotherapy for early breast cancer. Breast Cancer Res Treat 182, 631–642 (2020). https://doi.org/10.1007/s10549-020-05731-1
- Breast cancer
- Chemotherapy outcomes