Abstract
Simple SummaryWe aimed to determine the prognostic role of body composition in patients with breast cancer who received neoadjuvant chemotherapy. Previous studies suggested that body composition is a better indicator of breast cancer treatment outcome than body mass index. A comprehensive body composition analysis found that a low ratio of total visceral adipose tissue to subcutaneous adipose tissue was associated with shorter overall survival. This finding will lead to further investigation of the role of body composition in outcomes for patients with locally advanced breast cancer.Our previous study indicated that a high amount of visceral adipose tissue was associated with poor survival outcomes in patients with early breast cancer who received neoadjuvant chemotherapy. However, inconsistency was observed in the prognostic role of body composition in breast cancer treatment outcomes. In the present study, we aimed to validate our previous research by performing a comprehensive body composition analysis in patients with a standardized clinical background. We included 198 patients with stage III breast cancer who underwent neoadjuvant chemotherapy between January 2007 and June 2015. The impact of body composition on pathologic complete response and survival outcomes was determined. Body composition measurements had no significant effect on pathologic complete response. Survival analysis showed a low ratio of total visceral adipose tissue to subcutaneous adipose tissue (V/S ratio ≤ 34) was associated with shorter overall survival. A changepoint method determined that a V/S ratio cutoff of 34 maximized the difference in overall survival. Our study indicated the prognostic effect of body composition measurements in patients with locally advanced breast cancer compared to those with early breast cancer. Further investigation will be needed to clarify the biological mechanism underlying the association of V/S ratio with prognosis in locally advanced breast cancer.
Highlights
Obesity is a major risk factor for metabolic dysfunction and is associated with poor treatment response and prognosis in breast cancer
We previously reported that patients with early breast cancer who had a higher amount of visceral adipose tissue (VAT) and the lower quality of VAT represented by the Hounsfield unit (HU) measured by computed tomography in the upper abdominal area had significantly shorter distant disease-free survival than those with a lower amount and higher quality of VAT, owing to increasing insulin resistance [9,10]
We found that a low ratio of V/S ratio was associated with shorter overall survival (OS)
Summary
Obesity is a major risk factor for metabolic dysfunction and is associated with poor treatment response and prognosis in breast cancer. A previous study showed that high body mass index (BMI) was associated with lower pathologic complete response (pCR). The prognostic value of BMI was sometimes inconsistent when used to evaluate breast cancer treatment outcomes [4,5,6]. A plausible explanation for the obesity paradox is that BMI does not always reflect body composition, defined as the constitution of fat, muscle mass, bone, and water in the body. Understanding body composition is important for breast cancer treatment because recent studies indicated that body composition could be an imaging biomarker for insulin resistance, response to treatment, and prognosis in patients with breast cancer [9,10,11]
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