Clinical and Nutritional Correlates of Survival in Breast Cancer.

Abstract

Abstract Background: Malnutrition can be a frequent manifestation of breast cancer and its treatment. Several nutritional assessment tools have varying levels of association with survival, and have been tested individually with different patient populations, sometimes making it difficult to assess the impact of one tool relative to the others. We therefore conducted a single-institution multivariate analysis of 3 most commonly used nutritional tools - Body Mass Index (BMI), Subjective Global Assessment (SGA) and bioimpedance-derived phase angle (PA).Material and Methods: A case series of 234 breast cancer patients treated at Cancer Treatment Centers of America. Using SGA, patients were classified as well nourished (SGA A), moderately malnourished (SGA B) or severely malnourished (SGA C). Cox proportional hazard models were used to evaluate the independent prognostic effects of SGA, PA and BMI after controlling for each other, stage at diagnosis and prior treatment history (newly diagnosed versus previously treated).Results: Of 234 patients, 74 were newly diagnosed while 160 had received prior treatment. 159 had early stage (I/II) disease at diagnosis, while 75 had late stage (III/IV). The median age at presentation was 52.8 years (range 25-75 years). The mean PA and BMI scores were 5.5 (std. dev = 1.1) and 28.7 (std. dev = 6.2) respectively. 171 patients were well-nourished (SGA A) while 63 were malnourished (SGA B/C). Multivariate Cox modeling, after adjusting for stage at diagnosis, prior treatment history and other nutritional variables, found that malnourished status (SGA B/C) was associated with a relative risk (RR) of 2.4 (95% CI: 1.5-3.9, p < 0.001). Late stage at diagnosis was associated with a RR of 2.0 (95% CI: 1.3-3.2; p = 0.003) and previously treated category was associated with a RR of 7.9 (95% CI: 3.9-15.8; p < 0.001). PA and BMI were found to be statistically non-significant.Discussion: We found that SGA A (well-nourished status) versus SGA B/C (moderate to severe malnourished status) identified patients with better survival outcomes independent of BMI, PA, stage at diagnosis and prior treatment history. Among the nutritional assessment tools evaluated, SGA emerged as the strongest predictor of survival in breast cancer. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6048.