In a study reported in JAMA Oncology, Caan et al found that computed tomography (CT)-derived sarcopenia and adiposity were associated with overall survival in women with nonmetastatic breast cancer.
The study involved data from 3,241 women from Kaiser Permanente of Northern California and Dana Farber Cancer Institute diagnosed between January 2000 and December 2013 with stage II or III breast cancer. Hazard ratios (HRs) were calculated to assess the associations of all-cause mortality with sarcopenia (< 40 skeletal muscle index), low muscle radiodensity, and total adipose tissue (TAT) derived from CT at diagnosis.
Analysis was adjusted for sociodemographic factors, tumor characteristics, treatment, body mass index, and other body composition measures. Patients had a median age of 54 years.
Factors Associated With Survival
Median follow-up was 6.0 years. Overall, 1,086 patients (34%) presented with sarcopenia and 1,199 patients (37%) had low muscle radiodensity. Increased risk of overall mortality was found in patients with vs without sarcopenia (HR = 1.41, 95% confidence interval [CI] = 1.18–1.69) and in those in the highest vs lowest TAT tertiles (HR = 1.35, 95% CI = 1.08–1.69). In analysis of sarcopenia and TAT, the highest mortality risk was found in patients with sarcopenia and high TAT (HR = 1.89, 95% CI = 1.30–2.73). No association of low muscle radiodensity with survival was observed. Body mass index alone was not significantly associated with overall mortality and did not accurately identify patients at increased risk of overall mortality based on body composition.
The investigators concluded, “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 [body mass index] and will help to guide interventions to optimize survival outcomes.”
Bette J. Caan, DrPH, of Kaiser Permanente’s Division of Research, is the corresponding author for the JAMA Oncology article.
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