Genç Meme Kanserli Hastalarda Vücut Kompozisyonunun Prognostik Etkileri

Öz

Giriş/Amaç:Kanser hastalarında, vücut kompozisyonunun prognoz üzerindeki etkisi yeni bir klinik ilgi alanıdır. Evre 2 veya 3 obezite (VKİ> 35) olan hastalarda sağ kalım, bir meta-analizde kontrol gruplarına oranla daha kötü olarak bulunmuştur. BMI kategorisi, vücut kompozisyonunu tam olarak temsil etmez ve gerçek kas ve yağ miktarını belirlemek için kullanımı zordur. Bilgisayarlı tomografi (BT) vücut kompozisyonunu kesin olarak belirlemek için sık kullanılan bir yöntemdir. Gereç ve Yöntemler:Tüm karın kasları (psoas, diken omurga, kuadratus lumborum) dış ve iç oblik ve rektus abdominis dahil olmak üzere aksiyal BT görüntüleri toplam iskelet kası alanı (SMA) hesaplandı. Ayrıca, subkütanöz adipoz ve viseral adipoz doku dağılımı (VAT, SAT) alanlarının aksiyal BT görüntüleri, adipoz doku için -30 ila -190 eşik değerleri kullanılarak cm2 cinsinden hesaplanmıştır. Bulgular:Seksen dört kadın çalışmaya dahil edildi. Hastaların çoğu normal veya aşırı ağırlıklı idi. İnvaziv karsinom NST, çalışma popülasyonunun % 94'ünde baskın histolojik alt tiplerdi. Sarkopenik ve sarkopenik olmayan hastaların sayısı sırasıyla 11 ve 68 idi. Her iki gruptaki hastalar için ortalama genel sağkalıma (OS) takip süresinin sonunda ulaşılamasa da, gruplar arasındaki fark istatistiksel olarak anlamsızdı. Her iki grup için ortanca OS'ye ulaşılmadı, düşük ve yüksek VAT grupları arasındaki fark istatistiksel olarak anlamlıydı. Çoklu analizlerde VAT bağımsız bir risk faktörü olarak saptandı. Sonuç:Bu çalışmada sarkopeninin 40 yaşın altındaki meme kanseri hastalarında görülebildiğini ve prognostik bir etkisi olmadığını gösterdik.

Anahtar Kelimeler

• Sarkopeni
• Viseral Yağ Dokusu
• Genç Meme Kanseri
• Prognoz

The Effect of The Body Composition to Prognosis in Young Breast Cancer Patients

Abstract

Objective:In cancer patients, the effect of the body composition on prognosis is a new clinical area of interest. In patients with class 2 or 3 obesity (BMI >35), survival found to be worse control groups in a pooled analysis. BMI category is not truly representing body composition and hard to use to determine the true muscle and fat quantity. Computed tomography (CT) is a frequent method to determine body composition precisely. Methods:Axial CT images, including all abdominal muscles (psoas, erector spinae, quadratus lumborum) external and internal oblique and rectus abdominis) total skeletal muscle area (SMA), was calculated. Besides, axial CT images of the body fat subcutaneous adipose and visceral adipose tissue distribution (VAT, SAT) areas were calculated in cm2 using threshold values of -30 to -190 for adipose tissue. Results:Eighty-four women were included in the study. Most of the patients were normal or over-weighted. Invasive carcinoma NST was the dominant histological subtypes, with 94% of the study population. The count of the sarcopenic and non-sarcopenic patients was 11 and 68 respectively. Although the median OS cannot be reached at the end of the follow-up period for both groups, the difference between groups statistically insignificant. The median OS was not reached for both groups, the difference between low and high TVAT groups was statistically significant. In multivariate analysis, TVAT was found to be an independent risk factor. Conclusion:In this study, we demonstrate sarcopenia may be seen in patients with breast cancer under 40 years old, and it may not have a prognostic effect.

Keywords

• Sarcopenia
• Visceral adipose tissue
• Young Breast Cancer
• Prognosis

References

1. 1 . J.A. Ligibel, D. Wollins, American society of clinical oncology obesity initiative: Rationale, progress, and future directions. J. Clin. Oncol. 2016; 34:4256-4260.
2. 2 . C.M. Hales, M.D. Carroll, C.D. Fryar, C.L. Ogden, Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. NCHS Data Brief. 2017; 288:1-8
3. 3 . E. Blaak, Gender differences in fat metabolism. Curr. Opin. Clin. Nutr. Metab. Care. 2001; 4:499–502.
4. 4 . E.B. Geer, W. Shen, Gender differences in insulin resistance, body composition, and energy balance. Gend. Med. 2009; 6:60–75.
5. 5 . M. Ebadi, L. Martin, S. Ghosh, C.J. Field, R. Lehner, V.E. Baracos, V.C. Mazurak, Subcutaneous adiposity is an independent predictor of mortality in cancer patients. Br. J. Cancer. 2017; 117:148-155.
6. 6 . C. Fontanella, B. Lederer, S. Gade, M. Vanoppen, J.U. Blohmer, S.D. Costa, C. Denkert, H. Eidtmann, B. Gerber, C. Hanusch, J. Hilfrich, J. Huober, A. Schneeweiss, S. Paepke, C. Jackisch, K. Mehta, V. Nekljudova, M. Untch, P. Neven, G. von Minckwitz, S. Loibl, Impact of body mass index on neoadjuvant treatment outcome: a pooled analysis of eight prospective neoadjuvant breast cancer trials. Breast Cancer Res. Treat. 2015; 150:127-139.
7. 7 . T. Iwase, R. Nakamura, N. Yamamoto, A. Yoshi, M. Itami, M. Miyazaki, The effect of molecular subtype and body mass index on neo-adjuvant chemotherapy in breast cancer patients, Breast. 2014; 23:264-272.
8. 8 . J.K. Litton, A.M. Gonzalez-Angulo, C.L. Warneke, A.U. Buzdar, S.W. Kau, M. Bondy, S. Mahabir, G.N. Hortobagyi, A.M. Brewster, Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J. Clin. Oncol. 2008; 26:4072-4077

9. 9 . G. V. Denis, M.S. Obin, “Metabolically healthy obesity”: Origins and implications. Mol. Aspects Med. 2013; 34:59–70.
10. 10 . C.M. Prado, J.R. Lieffers, L.J. McCargar, T. Reiman, M.B. Sawyer, L. Martin, V.E. Baracos, Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008; 9:629-635.
11. 11 . N. Noori, C.P. Kovesdy, R. Dukkipati, Y. Kim, U. Duong, R. Bross, A. Oreopoulos, A. Luna, D. Benner, J.D. Kopple, K. Kalantar-Zadeh, Survival predictability of lean and fat mass in men and women undergoing maintenance hemodialysis. Am. J. Clin. Nutr. 2010; 92:1060–1070.
12. 12 . N. Johns, N.A. Stephens, K.C.H. Fearon, Muscle wasting in cancer. Int. J. Biochem. Cell Biol. 2013; 45:2215–2229.
13. 13 . K.C.H. Fearon, D.J. Glass, D.C. Guttridge, Cancer cachexia: Mediators, signaling, and metabolic pathways. Cell Metab. 2012; 16;153–166.
14. 14 . K. Fearon, F. Strasser, S.D. Anker, I. Bosaeus, E. Bruera, R.L. Fainsinger, A. Jatoi, C. Loprinzi, N. MacDonald, G. Mantovani, M. Davis, M. Muscaritoli, F. Ottery, L. Radbruch, P. Ravasco, D. Walsh, A. Wilcock, S. Kaasa, V.E. Baracos, Definition and classification of cancer cachexia: An international consensus. Lancet Oncol. 2011; 12:489–495.
15. 15 . C. van de Bool, H.R. Gosker, B. van den Borst, C.M. Op den Kamp, I.G.M. Slot, A.M.W.J. Schols, Muscle Quality is More Impaired in Sarcopenic Patients With Chronic Obstructive Pulmonary Disease. J. Am. Med. Dir. Assoc. 2016; 17:415–420.
16. 16 . A.S. Ryan, F.M. Ivey, S. Prior, G. Li, C. Hafer-Macko, Skeletal muscle hypertrophy and muscle myostatin reduction after resistive training in stroke survivors. Stroke 2011; 42:416-420
17. 17 . V. Baracos, S.M.R. Kazemi-Bajestani, Clinical outcomes related to muscle mass in humans with cancer and catabolic illnesses. Int. J. Biochem. Cell Biol. 2013; 45:2302–2308.
18. 18 . E. Del Fabbro, H. Parsons, C.L. Warneke, K. Pulivarthi, J.K. Litton, R. Dev, S.L. Palla, A. Brewster, E. Bruera, The Relationship Between Body Composition and Response to Neoadjuvant Chemotherapy in Women with Operable Breast Cancer. Oncologist. 2012; 17:1240-1245.
19. 19 . T. Iwase, T. Sangai, T. Nagashima, M. Sakakibara, J. Sakakibara, S. Hayama, E. Ishigami, T. Masuda, M. Miyazaki, Impact of body fat distribution on neoadjuvant chemotherapy outcomes in advanced breast cancer patients. Cancer Med. 2016; 5:41-48.
20. 20 . C.M.M. Prado, V.E. Baracos, L.J. McCargar, T. Reiman, M. Mourtzakis, K. Tonkin, J.R. Mackey, S. Koski, E. Pituskin, M.B. Sawyer, Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin. Cancer Res. 2009; 15:2920-2926.
21. 21 . H.N. Rier, A. Jager, S. Sleijfer, J. van Rosmalen, M.C.J.M. Kock, M.D. Levin, Low muscle attenuation is a prognostic factor for survival in metastatic breast cancer patients treated with first line palliative chemotherapy. Breast 2017; 31:9-15.
22. 22 . S.S. Shachar, A.M. Deal, M. Weinberg, K.A. Nyrop, G.R. Williams, T.F. Nishijima, J.M. Benbow, H.B. Muss, Skeletal muscle measures as predictors of toxicity, hospitalization, and survival in patients with metastatic breast cancer receiving taxane-based chemotherapy. Clin. Cancer Res. 2017; 23:658–665.
23. 23 . A. Villaseñor, R. Ballard-Barbash, K. Baumgartner, R. Baumgartner, L. Bernstein, A. McTiernan, M.L. Neuhouser, Prevalence and prognostic effect of sarcopenia in breast cancer survivors: The HEAL Study. J. Cancer Surviv. 2012; 6:398-406.
24. 24 . J. V. White, P. Guenter, G. Jensen, A. Malone, M. Schofield, Consensus statement: Academy of nutrition and dietetics and American society for parenteral and enteral nutrition: Characteristics recommended for the identification and documentation of adult malnutrition undernutrition .. J. Parenter. Enter. Nutr. 2012; 36:275-283.
25. 25 . W. Shen, M. Punyanitya, Z.M. Wang, D. Gallagher, M.P. St.-Onge, J. Albu, S.B. Heymsfield, S. Heshka, Total body skeletal muscle and adipose tissue volumes: Estimation from a single abdominal cross-sectional image. J. Appl. Physiol. 2004; 97:2333-2338
26. 26 . A.M.J. Sanchez, A. Csibi, A. Raibon, A. Docquier, J. Lagirand-Cantaloube, M.-P. Leibovitch, S.A. Leibovitch, H. Bernardi, eIF3f: a central regulator of the antagonism atrophy/hypertrophy in skeletal muscle. Int. J. Biochem. Cell Biol. 2013; 45:2158–2162.
27. 27 . S.H. Lecker, R.T. Jagoe, A. Gilbert, M. Gomes, V. Baracos, J. Bailey, S.R. Price, W.E. Mitch, A.L. Goldberg, Multiple types of skeletal muscle atrophy involve a common program of changes in gene expression. FASEB J. 2004; 18:39-51.
28. 28 . M. Pressoir, S. Desné, D. Berchery, G. Rossignol, B. Poiree, M. Meslier, S. Traversier, M. Vittot, M. Simon, J.P. Gekiere, J. Meuric, F. Serot, M.N. Falewee, I. Rodrigues, P. Senesse, M.P. Vasson, F. Chelle, B. Maget, S. Antoun, P. Bachmann, Prevalence, risk factors and clinical implications of malnutrition in french comprehensive cancer centres, Br. J. Cancer. 2010; 102:966-971.
29. 29 . D. Nishikawa, N. Hanai, H. Suzuki, Y. Koide, S. Beppu, Y. Hasegawa, The Impact of Skeletal Muscle Depletion on Head and Neck Squamous Cell Carcinoma. ORL. 2018; 80:1-9.
30. 30 . L. Martin, L. Birdsell, N. MacDonald, T. Reiman, M.T. Clandinin, L.J. McCargar, R. Murphy, S. Ghosh, M.B. Sawyer, V.E. Baracos, Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J. Clin. Oncol. 2013; 31:1539-1547
31. 31 . S. O’Brien, M. Twomey, F. Moloney, R.G. Kavanagh, B.W. Carey, D. Power, M.M. Maher, O.J. O’Connor, C. Ó’Súilleabháin, Sarcopenia and post-operative morbidity and mortality in patients with gastric cancer. J. Gastric Cancer 2018; 18:242-252.
32. 32 . M.L. Kwan, W.Y. Chen, C.H. Kroenke, E.K. Weltzien, J.M. Beasley, S.J. Nechuta, E.M. Poole, W. Lu, M.D. Holmes, C.P. Quesenberry, J.P. Pierce, X.O. Shu, B.J. Caan, Pre-diagnosis body mass index and survival after breast cancer in the after Breast Cancer Pooling Project. Breast Cancer Res. Treat. 2012; 132:729-739.
33. 33 . D.S.M. Chan, A.R. Vieira, D. Aune, E. V. Bandera, D.C. Greenwood, A. McTiernan, D. Navarro Rosenblatt, I. Thune, R. Vieira, T. Norat, Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann. Oncol. 2014; 25:1901–1914.
34. 34 . H. Greenlee, J.M. Unger, M. LeBlanc, S. Ramsey, D.L. Hershman, Association between body mass index and cancer survival in a pooled analysis of 22 clinical trials, in: Cancer Epidemiol. Biomarkers Prev., 2017; 19:310-322.
35. 35 . B.J. Caan, E.M. Cespedes Feliciano, C.M. Prado, S. Alexeeff, C.H. Kroenke, P. Bradshaw, C.P. Quesenberry, E.K. Weltzien, A.L. Castillo, T.A. Olobatuyi, W.Y. Chen, Association of muscle and adiposity measured by computed tomography with survival in patients with nonmetastatic breast cancer. JAMA Oncol. 2018; 4:798-804.
36. 36 . E.M.C. Feliciano, C.H. Kroenke, J.A. Meyerhardt, C.M. Prado, P.T. Bradshaw, M.L. Kwan, J. Xiao, S. Alexeeff, D. Corley, E. Weltzien, A.L. Castillo, B.J. Caan, Association of Systemic Inflammation and Sarcopenia With Survival in Nonmetastatic Colorectal Cancer: Results From the C SCANS Study. JAMA Oncol. 2017; 3:72319.
37. 37 . G. Malietzis, G.H. Lee, D. Bernardo, A.I.F. Blakemore, S.C. Knight, M. Moorghen, H.O. Al-Hassi, J.T. Jenkins, The prognostic significance and relationship with body composition of CCR7-positive cells in colorectal cancer. J. Surg. Oncol. 2015; 112:86-92.
38. 38 . G. Malietzis, N. Johns, H.O. Al-Hassi, S.C. Knight, R.H. Kennedy, K.C.H. Fearon, O. Aziz, J.T. Jenkins, Low muscularity and myosteatosis is related to the host systemic inflammator y response in patients undergoing surger y for colorectal cancer. Ann. Surg. 2016; 263:320-325.