Adipose Tissue Distribution and Survival Among Women with Nonmetastatic Breast Cancer

Abstract

OBJECTIVE: Previous studies of breast cancer survival have not considered specific depots of adipose tissue such as subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). METHODS: We assessed these relationships among 3,235 women with stage II/III breast cancer diagnosed between 2005–2013 at Kaiser Permanente Northern California and 2000–2012 at the Dana Farber Cancer Institute. SAT and VAT areas (cm2) were calculated from routine CT scans within 6 (median: 1.2) months of diagnosis, covariates were collected from electronic health records, and vital status was assessed by death records. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression. RESULTS: SAT and VAT ranged from 19.0–891 cm2 and 0.484–454 cm2, respectively. SAT was related to increased risk of death [127 cm2 increase, HR (95% CI): 1.13 (1.02, 1.26)] but no relationship with VAT [78.18 cm2 increase: 1.02 (0.91, 1.14)]. An association with VAT was noted among women with stage II cancer [stage II: 1.17 (0.99, 1.39); stage III: 0.90 (0.76, 1.07); p-interaction: <0.01]. Joint increases in SAT and VAT were associated with mortality above either alone [simultaneous 1-SD increase: 1.19 (1.05, 1.34)]. CONCLUSIONS: SAT may be an underappreciated risk factor for breast cancer-related death.

Evaluation of automated computed tomography segmentation to assess body composition and mortality associations in cancer patients

“…Both studies found associations of body composition (assessed using manual analysis) with overall survival. [16][17][18][19] To be eligible, patients had to be aged 18 to 80 years at diagnosis, have no prior cancer history, and have an abdominal or pelvic CT scan available at diagnosis for analysis. CT scans came from a variety of clinical centres spread over KPNC's 21 hospitals and over 200 outpatient clinics and included contrast, non-contrast, and PET-CTs.…”

Aberrant Zip14 expression in muscle is associated with cachexia in a Bard1‐deficient mouse model of breast cancer metastasis

“…[10][11][12] However, recent advances in computed tomography (CT)-based body composition analysis 13 have revealed that skeletal muscle wasting is often masked in breast cancer patients by excess adipose tissue (due to obesity or anticancer treatments). [14][15][16][17][18][19] Imaging studies by the Prado group confirmed that age-related loss of muscle mass and decline in physical strength and functional ability (known as sarcopenia) occur in 25% of metastatic breast cancer patients and are the significant predictors of toxicity to antineoplastic agents and time to tumor progression. 14,16,19 Additional studies observed muscle weakness and body pain in 39% of breast cancer patients, leading to functional limitations and increased morbidity.…”

Prognostic Significance of Abdominal-to-Gluteofemoral Adipose Tissue Distribution in Patients with Breast Cancer

“…In contrast, some studies have failed to show a significant association between obesity and clinical outcomes in breast cancer patients [9,10,11]. These inconsistent results are thought to result from inaccuracies in the body mass index (BMI) as a measure of body fat amount [12]. Although BMI is the most commonly used scale for defining overweight and obese patients in clinical studies, it cannot distinguish between AT mass and non-fatty tissue mass [12,13].…”

“…In diabetes and cardiovascular disease, the amount of VAT and abdominal SAT was positively correlated with disease risk, while gluteofemoral AT played a protective role [17,18]. Since BMI cannot reflect the distribution of AT in the body, the waist-to-hip circumference ratio is used to estimate the central adiposity in clinical studies of malignant diseases [12,14,15]. In previous studies of breast cancer patients, an increased waist-to-hip circumference ratio was found to be associated with poor prognosis, suggesting the prognostic significance of abdominal AT [14,15].…”

“…Recently, several studies have used imaging techniques such as computed tomography (CT) to assess the amount and distribution of AT, because imaging examinations can provide a more refined method to measure obesity than BMI [12,13,20,21]. Using CT images, the amount of VAT and abdominal SAT can be separately and accurately measured, as well as the total AT [12,13,22]. Furthermore, qualitative features of AT can be assessed through CT-attenuation of AT, expressed as Hounsfield units (HU).…”