Metabolic Syndrome Predicts Response to Neoadjuvant Chemotherapy in Breast Cancer

Ying Lu; Pinxiu Wang; Ning Lan; Fei Kong; Awaguli Abdumijit; Shiyan Tu; Yanting Li; Wenzhen Yuan

doi:10.3389/fonc.2022.899335

Metabolic Syndrome Predicts Response to Neoadjuvant Chemotherapy in Breast Cancer

Front Oncol. 2022 Jul 1:12:899335. doi: 10.3389/fonc.2022.899335. eCollection 2022.

Authors

Ying Lu¹, Pinxiu Wang¹, Ning Lan¹, Fei Kong¹, Awaguli Abdumijit¹, Shiyan Tu¹, Yanting Li¹, Wenzhen Yuan²

Affiliations

¹ The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
² The Department of Oncology, The First Hospital of Lanzhou University, Lanzhou, China.

Abstract

Purpose: This research investigated the predictive role of metabolic syndrome (MetS) in breast cancer neoadjuvant chemotherapy (BCNACT) response.

Methods: One hundred fifty primary breast cancer (BC) patients who underwent neoadjuvant chemotherapy (NACT) were included retrospectively. MetS, MetS components [waist circumference (WC), fasting blood glucose (FBG), blood pressure, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C)], serum lipid, and other MetS-related laboratory indicators within two weeks before BCNACT were evaluated. Univariate, multivariate, and subgroup analyses were performed to determine the predictors of BCNACT pathologic complete response (pCR), clinical response, and pathologic response. The effectiveness of the model was evaluated via receiver operating characteristic curve (ROC) and calibration curve. External validation was performed through 135 patients.

Results: Univariate analysis revealed that MetS before BCNACT predicted poor BCNACT response (pCR, P = 0.003; clinical response, P = 0.033; pathologic response, P < 0.001). Multivariate analysis confirmed that MetS before BCNACT predicted lower pCR rate (P = 0.041). Subgroup analysis showed that this relationship was significant in estrogen receptor (ER) (-) (RR = 0.266; 95% CI, 0.074-0.954), human epidermal growth factor 2 (HER2) (-) (RR = 0.833; 95% CI, 0.740-0.939) and TNBC (RR = 0.833; 95% CI, 0.636-0.995). Multivariate analysis of external validation confirmed that pretreatment MetS was associated with a lower pCR rate (P = 0.003), and subgroup analysis also confirmed that this relationship had significant statistical differences in ER (-), HER2 (-), and TNBC subgroups.

Conclusions: MetS before BCNACT predicted a lower pCR rate. Intervention on MetS status, especially in ER (-), HER2 (-), and TNBC subgroups, is expected to improve the response rate of BCNACT further.

Keywords: MP grading; RECIST criteria; breast cancer; efficacy prediction; metabolic syndrome; neoadjuvant chemotherapy.