Predictive and prognostic effect of computed tomography-derived body composition analysis during neoadjuvant chemotherapy for operable and locally advanced breast cancer

Ilaria Trestini; Alberto Caldart; Marco Cintoni; Isabella Sperduti; Alessandro Drudi; Gregorio Aluffi; Elena Fiorio; Veronica Parolin; Valentina Zambonin; Sara Zanelli; Daniela Tregnago; Alice Avancini; Sara Pilotto; Irene Aprili; Emanuela Zandonà; Mirko D'Onofrio; Maria Cristina Mele; Antonio Gasbarrini; Giovanni Scambia; Giampaolo Tortora; Michele Milella; Emilio Bria; Luisa Carbognin

doi:10.1016/j.nut.2022.111858

Predictive and prognostic effect of computed tomography-derived body composition analysis during neoadjuvant chemotherapy for operable and locally advanced breast cancer

Nutrition. 2023 Jan:105:111858. doi: 10.1016/j.nut.2022.111858. Epub 2022 Oct 1.

Authors

Ilaria Trestini¹, Alberto Caldart², Marco Cintoni³, Isabella Sperduti⁴, Alessandro Drudi⁵, Gregorio Aluffi⁵, Elena Fiorio², Veronica Parolin², Valentina Zambonin², Sara Zanelli², Daniela Tregnago², Alice Avancini⁶, Sara Pilotto², Irene Aprili⁷, Emanuela Zandonà⁷, Mirko D'Onofrio⁵, Maria Cristina Mele⁸, Antonio Gasbarrini⁹, Giovanni Scambia¹⁰, Giampaolo Tortora¹¹, Michele Milella², Emilio Bria¹¹, Luisa Carbognin¹²

Affiliations

¹ Dietetic Service, Medical Direction, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy. Electronic address: ilaria.trestini@aovr.veneto.it.
² Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
³ Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
⁴ Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
⁵ Department of Radiology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
⁶ Biomedical Sciences, Department of Medicine, University of Verona, Italy.
⁷ Medical Direction, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
⁸ Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
⁹ Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; Internal Medicine and Gastroenterology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
¹⁰ Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
¹¹ Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; Medical Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
¹² Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

PMID: 36323147
DOI: 10.1016/j.nut.2022.111858

Abstract

Objectives: Excess adiposity is associated with several factors involved in carcinogenesis and breast cancer progression. Evidence supporting the role of body composition in breast cancer treatment is promising, but still scanty and mainly focused on adjuvant treatment. The aim of this study was to evaluate the changes in body composition during neoadjuvant chemotherapy and its association with pathologic complete response and survival outcome in patients treated for operable/locally advanced breast cancer.

Methods: A retrospective review of patients with breast cancer treated with neoadjuvant chemotherapy was performed in the Oncology Section of the Department of Medicine, University of Verona between 2014 and 2019. Body composition was evaluated from clinically acquired computed tomography scans at diagnosis and after neoadjuvant chemotherapy. Descriptive statistic was adopted. The associations of body composition measures with pathologic complete response and disease-free survival were analyzed. Kaplan-Meier curves were compared with log-rank analysis.

Results: Data from 93 patients were collected. After neoadjuvant chemotherapy, the adipose compound changed significantly across all body mass index categories. Body composition parameters had no significant effect on pathologic complete response. Survival analysis showed that a high gain of visceral adipose tissue during neoadjuvant chemotherapy was associated with shorter disease-free survival (hazard ratio, 10.2; P = 0.026). In particular, disease-free survival was significantly worse in patients who gained ≥10% of visceral adipose tissue compared with patients who gained <10% of visceral adipose tissue (5-y disease-free survival 71.4 versus 96.3, P = 0.009, respectively).

Conclusions: Our results indicated that neoadjuvant chemotherapy significantly affects body composition, which seems to have an effect on survival outcome of breast cancer, highlighting the relevance of the body composition assessment when estimating treatment outcomes.

Keywords: Body composition; Breast cancer; Neoadjuvant chemotherapy; Survival; Visceral adipose tissue.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Body Composition
Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / drug therapy
Female
Humans
Neoadjuvant Therapy*
Prognosis
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome