The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer.
BACKGROUND
Overweight women diagnosed with breast cancer have greater recurrence and mortality risks. Recent studies in advanced cancer showed that the combination of sarcopenia and an overweight or obese body mass index (BMI) is associated with poor clinical outcomes.


OBJECTIVE
To compare pathological complete response (pCR) cases with controls and evaluate associations among a pCR, survival outcome, and sarcopenia as well as the combination of both sarcopenia and a BMI ≥25 kg/m(2).


METHODS
Sixty-seven breast cancer patients with a pCR to neoadjuvant chemotherapy (NC) were matched with controls who did not have a pCR to NC. Patients were matched by age, Black's nuclear grading system, clinical cancer stage, and estrogen receptor and progesterone receptor status. Body composition was analyzed using computed tomography images taken prior to NC.


RESULTS
BMI was associated with pCR. Among normal weight patients, the pCR rate was higher in sarcopenic patients and the progression-free survival (PFS) interval was significantly longer than in overweight or obese BMI patients. The death hazard was 2% higher for each unit higher skeletal muscle index and 0.6% higher for each unit higher visceral adipose tissue.


CONCLUSIONS
Overweight patients treated with NC had a lower pCR rate and shorter PFS time. Among patients with a normal BMI, the pCR rate was better in sarcopenic patients. More research is required to evaluate the negative impact of sarcopenic obesity on prognosis and the contributors to better response rates in operable, normal weight breast cancer patients with sarcopenia.
Division of Hematology/Oncology and Palliative Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia 23284, USA. edelfabbro@vcu.edu
Egidio
E
Del Fabbro
Henrique
H
Parsons
Carla L
CL
Warneke
Kalyan
K
Pulivarthi
Jennifer K
JK
Litton
Rony
R
Dev
Shana L
SL
Palla
Abenaa
A
Brewster
Eduardo
E
Bruera
D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009765:Obesity / Q000503:physiopathology; D050177:Overweight / Q000503:physiopathology; D055948:Sarcopenia / Q000503:physiopathology; D015996:Survival Rate; D016896:Treatment Outcome