Evaluation of sarcopenia-associated survival in breast cancer with computed tomography-based pectoral muscle area measurements

Abstract

Objective: Breast cancer is the most common and deadly female cancer. In breast cancer cases, survival is closely related to muscle mass, which is one of the components of body composition. Our aim was to investigate the usefulness of computed-tomography (CT)- based pectoral muscle measurements in detecting sarcopenia in patients with non-metastatic breast cancer and the relationship of these measurements with survival. Patients and Methods: Our study included 62 adult female breast cancer cases diagnosed with breast cancer between January 2012 and January 2018 and without metastasis in positron emission tomography/CT (PET/CT) examination obtained for pre-treatment staging. To evaluate sarcopenia, skeletal muscle index (SMI) and pectoral muscle index (PMI) were calculated by measuring pectoral muscle area and skeletal muscle area at L3 vertebra level on PET/CT images. Results: Deceased patients were significantly older (Median=73.90, IQR=27.04) than surviving patients (Median=54.60, IQR=13.37, p=0.025) and were diagnosed with cancer later in life (Median=63.92 IQR=30.16’ vs. Median=47.51 IQR=15.0, p=0.030). When the threshold of 31 cm2/m2 was selected, there was a statistically significant difference in survival between sarcopenic and non-sarcopenic groups (p=0.031). Conclusion: In conclusion, the presence of sarcopenia in female breast cancer cases is a parameter that affects survival and can be measured using radiological imaging methods. In addition to the measurements accepted in the literature regarding sarcopenia, pectoral muscle measurements can be chosen as an alternative method in the diagnosis of sarcopenia.

Keywords

• Breast cancer
• Computed tomography
• Sarcopenia
• Pectoral muscle

References

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. CA Cancer J Clin 2021;71:209-49. doi:10.3322/caac.21660
2. Globocan. Cancer today. International Agency for research. Published 2020. Accessed July 8, 2023. https://gco.iarc.fr/ today/fact-sheets-populations
3. Momenimovahed Z, Salehiniya H. Epidemiological characteristics of and risk factors for breast cancer in the world. Breast Cancer Res Treat 2019;11:151-64. doi:10.2147/ BCTT.S176070
4. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. Body fatness and cancer — Viewpoint of the IARC working Group. N Engl J Med 2016;375:794-8. doi:10.1056/ NEJMsr1606602
5. Muscaritoli M, Anker SD, Argilés J, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: Joint document elaborated by Special Interest Groups (SIG) “ cachexiaanorexia in chronic wasting diseases” and “ nutrition in geriatrics.” . Clinical Nutr 2010;29:154-9. doi:10.1016/j. clnu.2009.12.004
6. Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. J Lab Clin Med 2001;137:231-43. doi:10.1067/ mlc.2001.113504
7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412-23. doi:10.1093/ageing/afq034
8. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet 2008;9:629-35. doi:10.1016/ S1470-2045(08)70153-0

9. Rossi F, Valdora F, Barabino E, Calabrese M, Tagliafico AS. Muscle mass estimation on breast magnetic resonance imaging in breast cancer patients: comparison between psoas muscle area on computer tomography and pectoralis muscle area on MRI. Eur Radiol 2019;29:494-500. doi:10.1007/ s00330.018.5663-0
10. Shen W, Punyanitya M, Wang ZM, et al. Total body skeletal muscle and adipose tissue volumes: Estimation from a single abdominal cross-sectional image. J Appl Physiol 2004;97:2333- 8. doi:10.1152/japplphysiol.00744.2004
11. Jones KI, Doleman B, Scott S, Lund JN, Williams JP. Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications. Colorectal Dis 2015;17:O20-O26. doi:10.1111/ codi.12805
12. Tosato M, Marzetti E, Cesari M, et al. Measurement of muscle mass in sarcopenia: from imaging to biochemical markers. Aging 2017;29:19-27. doi:10.1007/s40520.016.0717-0
13. Sanders KJC, Degens JHRJ, Dingemans AMC, Schols AMWJ. Cross-sectional and longitudinal assessment of muscle from regular chest computed tomography scans: L1 and pectoralis muscle compared to L3 as reference in non-small cell lung cancer. Int Journal COPD 2019;14:781-9. doi:10.2147/COPD. S194003
14. Hemke R, Buckless C, Torriani M. Quantitative imaging of body composition. Semin Radiol 2020;24:375-85. doi:10.1055/s-0040.170.8824 [15] Pi-Sunyer FX. Obesity: criteria and classification. Proc Nutr Soc 2000;59:505-9. doi:10.1017/s002.966.5100000732
15. Lee JS, Kim YS, Kim EY, Jin W. Prognostic significance of CT-determined sarcopenia in patients with advanced gastric cancer. PLoS ONE 2018;13:e0202700. doi:10.1371/journal. pone.0202700
16. Go SI, Park MJ, Song HN, et al. A comparison of pectoralis versus lumbar skeletal muscle indices for defining sarcopenia in diffuse large B-cell lymphoma – two are better than one. Oncotarget 2017;8:47007-19. doi:10.18632/oncotarget.16552
17. Kinsey C M, San José Estépar R, van der Velden J, Cole BF, Christiani DC, Washko GR. Lower pectoralis muscle area is associated with a worse overall survival in non–small cell lung cancer. Cancer Epidemiol Biomarkers Prev 2017;26:38-43. doi: 10.1158/1055-9965.EPI-15-1067
18. Prado CMM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet 2008;9:629-35. doi:10.1016/ S1470-2045(08)70153-0
19. Aleixo GFP, Williams GR, Nyrop KA, Muss HB, Shachar SS. Muscle composition and outcomes in patients with breast cancer: meta-analysis and systematic review. Breast Cancer Res Treat 2019;177:569-79. doi:10.1007/s10549.019.05352-3
20. Rossi F, Valdora F, Bignotti B, Torri L, Succio G, Tagliafico AS. Evaluation of body Computed Tomography-determined sarcopenia in breast cancer patients and clinical outcomes: A systematic review. Cancer Treat Res 2019;21:100154. doi:10.1016/j.ctarc.2019.100154
21. Zhang XM, Dou QL, Zeng Y, Yang Y, Cheng ASK, Zhang WW. Sarcopenia as a predictor of mortality in women with breast cancer: A meta-analysis and systematic review. BMC Cancer 2020;20:172. doi:10.1186/s12885.020.6645-6
22. Del Fabbro E, Parsons H, Warneke CL, et al. The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer. Oncologist 2012;17:1240-5. doi:10.1634/ theoncologist.2012-0169
23. McDonald MLN, Diaz AA, Ross JC, et al. Quantitative computed tomography measures of pectoralis muscle area and disease severity in chronic obstructive pulmonary disease. a cross-sectional study. Ann Thorac Surg 2014;11:326-34. doi:10.1513/AnnalsATS.201307-229OC
24. Teigen LM, John R, Kuchnia AJ, et al. Preoperative pectoralis muscle quantity and attenuation by computed tomography are novel and powerful predictors of mortality after left ventricular assist device implantation. Circ Heart Fail 2017;10:e004069. doi:10.1161/CIRCHEARTFAILURE.117.004069
25. Hocaoglu E, Ors S, Yildiz O, Inci E. Correlation of pectoralis muscle volume and density with severity of COVID-19 pneumonia in adults. Acad Radiol 2021;28:166-72. doi:10.1016/j.acra.2020.11.017
26. Meyer HJ, Kardas H, Schramm D, et al. CT-defined pectoralis muscle mass and muscle density are associated with mortality in acute pulmonary embolism. A multicenter analysis. Clin Nutr 2023;42:1036-40. doi:10.1016/j.clnu.2023.04.022
27. Villaseñor A, Ballard-Barbash R, Baumgartner K, et al. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. J Cancer Survivorship 2012;6:398- 406. doi:10.1007/s11764.012.0234-x
28. Foukakis T, Bergh J. Prognostic and predictive factors in early, non-metastatic breast cancer. Dizon Ed UpToDate 2016.
29. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999;341:1097-105. doi:10.1056/ NEJM199.910.073411501
30. Obesity and overweight. Accessed July 8, 2023. https:// www.who.int/news-room/fact-sheets/detail/obesity-andoverweight
31. Flegal KM, Graubard BI, Williamson DF, Gail MH. Causespecific excess deaths associated with underweight, overweight, and obesity. JAMA 2007;298:2028-37. doi:10.1001/jama.298.17.2028
32. Van Den Brandt PA, Spiegelman D, Yaun SS, et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol 2000;152:514-27. doi:10.1093/aje/152.6.514
33. White AJ, Nichols HB, Bradshaw PT, Sandler DP. Overall and central adiposity and breast cancer risk in the sister study. Cancer 2015;121:3700-8. doi:10.1002/cncr.29552