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Sarcopenia detected with bioelectrical impedance versus CT scan and chemotherapy tolerance in patients with early breast cancer

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Abstract

Background

Early breast cancer (EBC) is a potentially curable disease. Some patients with EBC require chemotherapy, exposing patients to undesirable side effects. Loss of muscle mass, or sarcopenia, has been associated with worse outcomes in patients with EBC and worse treatment-related toxicity in patients with advanced breast cancer. CT scans can identify sarcopenia; however, most patients with EBC do not require routine CT scans. Bioelectrical impedance spectrometry (BIS) is another method to detect sarcopenia and can be performed quickly in the office without radiation exposure. We sought to investigate whether sarcopenia measurements by CT scan versus BIS correlated with each other and whether sarcopenia identified by each method is associated with chemotherapy toxicity and adherence in patients with EBC.

Methods

This is a retrospective study; eligible patients received chemotherapy treatment for EBC and had undergone BIS. A subset of patients had also had a CT abdomen with a Lumbar L3 level. Measures of sarcopenia were obtained from the BIS and CT data. In addition, patient characteristics, treatment, and toxicity-related outcomes were obtained from medical records.

Multivariate logistic regression models were used to associate sarcopenia status with toxicity endpoints, adjusted for other patient characteristics.

Results

There was a moderate correlation between sarcopenia detected by CT scan and BIS (r = 0.64 p < 0.0001). Patients with sarcopenia detected by BIS had more chemotherapy toxicity (OR = 2.56; CI 1.72–3.84), dose reductions or dose delays (OR = 1.58; CI 1.06–2.38), and hospitalizations (OR = 2.38; CI 1.33–4.16) due to side effects than patients without sarcopenia.

Conclusion

The presence of sarcopenia in patients with EBC is associated with worse chemotherapy tolerance. BIS represents a high-value alternative to CT scans for sarcopenia assessment.

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References

  1. Breast cancer statistics 2022 [Available from: https://seer.cancer.gov/statfacts/html/breast.html.

  2. Gradishar WJ, Moran MS, Abraham J, Agnese D, Allison KH, et al. NCCN guidelines(R) insights: breast cancer, version 4.2021. J Natl Compr Canc Netw. 2021;19(5):484–93. https://doi.org/10.6004/jnccn.2021.0023. (1540-1413 (Electronic) 1540-1405 (Linking)).

    Article  Google Scholar 

  3. 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(3):569–79. https://doi.org/10.1007/s10549-019-05352-3. (1573-7217 (Electronic) 0167-6806 (Linking)).

    Article  CAS  Google Scholar 

  4. Rier HN, Jager A, Sleijfer S, Maier AB, Levin MD. The prevalence and prognostic value of low muscle mass in cancer patients: a review of the literature. Oncologist. 2016;21(11):1396–409. https://doi.org/10.1634/theoncologist.2016-0066. (1549-490X (Electronic) 1083-7159 (Linking)).

    Article  Google Scholar 

  5. Shachar SS, Deal AM, Weinberg M, Nyrop KA, Williams GR, Nishijima TF, et al. 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(3):658–65. https://doi.org/10.1158/1078-0432.CCR-16-0940. (1557-3265 (Electronic) 1078-0432 (Linking)).

    Article  CAS  Google Scholar 

  6. Shachar SS, Deal AM, Weinberg M, Williams GR, Nyrop KA, Popuri K, et al. Body composition as a predictor of toxicity in patients receiving anthracycline and taxane-based chemotherapy for early-stage breast cancer. Clin Cancer Res. 2017;23(14):3537–43. https://doi.org/10.1158/1078-0432.CCR-16-2266. (1557-3265 (Electronic) 1078-0432 (Linking)).

    Article  CAS  Google Scholar 

  7. Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer. 2016;57:58–67. https://doi.org/10.1016/j.ejca.2015.12.030. (1879-0852 (Electronic) 0959-8049 (Linking)).

    Article  Google Scholar 

  8. Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Invasive breast cancer. J Natl Compr Canc Netw. 2011;9(2):136–222. https://doi.org/10.6004/jnccn.2011.0016. (1540-1413 (Electronic) 1540-1405 (Linking)).

    Article  CAS  Google Scholar 

  9. Aleixo GFP, Shachar SS, Nyrop KA, Muss HB, Battaglini CL, Williams GR. Bioelectrical impedance analysis for the assessment of sarcopenia in patients with cancer: a systematic review. Oncologist. 2020;25(2):170–82. https://doi.org/10.1634/theoncologist.2019-0600. (1549-490X (Electronic) 1083-7159 (Linking)).

    Article  Google Scholar 

  10. Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 2017 [Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf.

  11. Otten L, Stobaus N, Franz K, Genton L, Muller-Werdan U, Wirth R, et al. impact of sarcopenia on 1-year mortality in older patients with cancer. Age Ageing. 2019;48(3):413–8. https://doi.org/10.1093/ageing/afy212. (1468-2834 (Electronic) 0002-0729 (Linking)).

    Article  Google Scholar 

  12. Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69–71 (1995-7270 (Electronic) 1995-7262 (Linking)).

    CAS  Google Scholar 

  13. Prado CM, Lima IS, Baracos VE, Bies RR, McCargar LJ, Reiman T, et al. An exploratory study of body composition as a determinant of epirubicin pharmacokinetics and toxicity. Cancer Chemother Pharmacol. 2011;67(1):93–101. https://doi.org/10.1007/s00280-010-1288-y. (1432-0843 (Electronic) 0344-5704 (Linking)).

    Article  CAS  Google Scholar 

  14. Caan BJ, Cespedes Feliciano EM, Prado CM, Alexeeff S, Kroenke CH, Bradshaw P, et al. Association of muscle and adiposity measured by computed tomography with survival in patients with nonmetastatic breast cancer. JAMA Oncol. 2018;4(6):798–804. https://doi.org/10.1001/jamaoncol.2018.0137. (2374-2445 (Electronic) 2374-2437 (Linking)).

    Article  Google Scholar 

  15. Williams GR, Deal AM, Shachar SS, Walko CM, Patel JN, O’Neil B, et al. The impact of skeletal muscle on the pharmacokinetics and toxicity of 5-fluorouracil in colorectal cancer. Cancer Chemother Pharmacol. 2018;81(2):413–7. https://doi.org/10.1007/s00280-017-3487-2. (1432-0843 (Electronic) 0344-5704 (Linking)).

    Article  CAS  Google Scholar 

  16. Mir O, Coriat R, Blanchet B, Durand JP, Boudou-Rouquette P, Michels J, et al. Sarcopenia predicts early dose-limiting toxicities and pharmacokinetics of sorafenib in patients with hepatocellular carcinoma. PLoS ONE. 2012;7(5): e37563. https://doi.org/10.1371/journal.pone.0037563. (1932-6203 (Electronic) 1932-6203 (Linking)).

    Article  CAS  Google Scholar 

  17. Desmedt C, Fornili M, Clatot F, Demicheli R, De Bortoli D, Di Leo A, et al. Differential benefit of adjuvant docetaxel-based chemotherapy in patients with early breast cancer according to baseline body mass index. J Clin Oncol. 2020;38(25):2883–91. https://doi.org/10.1200/JCO.19.01771. (1527-7755 (Electronic) 0732-183X (Linking)).

    Article  CAS  Google Scholar 

  18. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):601. https://doi.org/10.1093/ageing/afz046. (1468-2834 (Electronic) 0002-0729 (Linking)).

    Article  Google Scholar 

  19. Cespedes Feliciano EM, Popuri K, Cobzas D, Baracos VE, Beg MF, Khan AD, et al. Evaluation of automated computed tomography segmentation to assess body composition and mortality associations in cancer patients. J Cachexia Sarcopenia Muscle. 2020;11(5):1258–69. https://doi.org/10.1002/jcsm.12573. (2190-6009 (Electronic) 2190-5991 (Linking)).

    Article  Google Scholar 

  20. Aleixo GFP, Yu H, Chen YT, Nyrop KA, Louie RJ, Deal AM, et al. Myosteatosis evaluation using erector spinae and psoas muscles to predict adverse events during adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat. 2021;186(2):487–95. https://doi.org/10.1007/s10549-020-06061-y. (1573-7217 (Electronic) 0167-6806 (Linking)).

    Article  CAS  Google Scholar 

  21. Hahn EE, Tang T, Lee JS, Munoz-Plaza C, Adesina JO, Shen E, et al. Use of imaging for staging of early-stage breast cancer in two integrated health care systems: adherence with a choosing wisely recommendation. J Oncol Pract. 2015;11(3):e320–8. https://doi.org/10.1200/JOP.2014.002998. (1935-469X (Electronic) 1554-7477 (Linking)).

    Article  Google Scholar 

  22. Adams SC, Segal RJ, McKenzie DC, Vallerand JR, Morielli AR, Mackey JR, et al. Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Breast Cancer Res Treat. 2016;158(3):497–507. https://doi.org/10.1007/s10549-016-3900-2. (1573-7217 (Electronic) 0167-6806 (Linking)).

    Article  CAS  Google Scholar 

  23. Kwak JY, Kwon KS. Pharmacological interventions for treatment of sarcopenia: current status of drug development for sarcopenia. Ann Geriatr Med Res. 2019;23(3):98–104. https://doi.org/10.4235/agmr.19.0028. (2508-4909 (Electronic) 2508-4798 (Linking)).

    Article  Google Scholar 

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Acknowledgements

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Funding

This study received support from the American Society of Hematology (ASH) HONORS award for the purchase of the software to read CT scans.

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Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Gabriel F. P. Aleixo

  2. Department of Surgery, Cleveland Clinic, Cleveland, OH, USA

    Stephanie A. Valente

  3. Department of Biostatistics, Cleveland Clinic, Cleveland, OH, USA

    Wei Wei

  4. Department of Imaging and Diagnostic Medicine, Cleveland Clinic, Cleveland, OH, USA

    Po-Hao Chen

  5. Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA

    Halle C. F. Moore

Authors
  1. Gabriel F. P. Aleixo
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  2. Stephanie A. Valente
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  3. Wei Wei
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  5. Halle C. F. Moore
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Contributions

The authors’ contributions: GFPA- Conceptualization, Methodology, Validation, Formal Analysis, Investigation, Resources, Data Curation, Writing – Original Draft, Writing – Review and Editing, Visualization, Project Administration. SV: Conceptualization, Methodology, Validation, Writing – Review and Editing. WW: Formal Analysis, Data Curation, Writing – Review and Editing. PHC: Methodology, Validation, Writing – Review and Editing. HCFM: Conceptualization, Methodology, Validation, Writing – Review and Editing, Supervision. Project Administration.

Corresponding author

Correspondence to Gabriel F. P. Aleixo.

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Conflict of interest

Dr. Stephanie A Valente serves as a consultant for SOZO. Dr. Halle Moore reports grants or contracts received by AstraZeneca, Roche/Genetech, Daiichi-Sankyo, Sermonix, and Seattle genetics. All other authors have no conflict of interest to report.

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Aleixo, G.F.P., Valente, S.A., Wei, W. et al. Sarcopenia detected with bioelectrical impedance versus CT scan and chemotherapy tolerance in patients with early breast cancer. Breast Cancer 30, 101–109 (2023). https://doi.org/10.1007/s12282-022-01401-w

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  • DOI: https://doi.org/10.1007/s12282-022-01401-w

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