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Poltronieri TS, Pérsico RS, Viana LV. Body adipose tissue depots and treatment outcomes for women with breast cancer: A systematic review. Clin Nutr 2024; 43:1033-1042. [PMID: 38547637 DOI: 10.1016/j.clnu.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 02/14/2024] [Accepted: 03/16/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND & AIMS Excessive adipose tissue is associated with poorer prognosis in women with breast cancer (BC). However, several body adiposity depots, such as visceral (VAT), subcutaneous (SAT), intermuscular (IMAT), and gluteofemoral adipose tissues (GFAT) may have heterogeneous metabolic roles and health effects in these patients. This systematic review aims to evaluate the impact of different body adipose tissue depots, assessed via computed tomography (CT), on treatment outcomes for women with BC. We hypothesize that distinct body adipose tissue depots may be associated differently with outcomes in patients with BC. METHODS A comprehensive bibliographical search was conducted using PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases (until January 2024). The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. RESULTS The final sample comprised 23 retrospective studies (n = 12,462), with fourteen presenting good quality. A lack of standardization in CT body adipose tissue depots measurement and outcome presentation precluded quantitative analysis. Furthermore, most included studies had heterogeneous clinical characteristics. Survival and treatment response were the most prevalent outcomes. VAT (n = 19) and SAT (n = 17) were the most frequently evaluated depots and their increase was associated with worse outcomes, mainly in terms of survival. IMAT (n = 4) presented contradictory findings and a higher GFAT (n = 1) was associated with better outcomes. CONCLUSION This systematic review found an association between increased VAT and SAT with worse outcomes in patients with BC. However, due to the heterogeneity of the included studies, further research with homogeneous methodologies is necessary to better understand the impact of body adipose tissue depots on treatment outcomes. Such knowledge could lead to improved care for this patient population.
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Affiliation(s)
- Taiara Scopel Poltronieri
- Programa de Pós-Graduação em Ciências Médicas, Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Raquel Stocker Pérsico
- Programa de Pós-Graduação em Ciências Médicas, Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Luciana Verçoza Viana
- Programa de Pós-Graduação em Ciências Médicas, Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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Roberto M, Barchiesi G, Resuli B, Verrico M, Speranza I, Cristofani L, Pediconi F, Tomao F, Botticelli A, Santini D. Sarcopenia in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:596. [PMID: 38339347 PMCID: PMC10854936 DOI: 10.3390/cancers16030596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: We estimated the prevalence and clinical outcomes of sarcopenia among breast cancer patients. (2) Methods: A systematic literature search was carried out for the period between July 2023 and October 2023. Studies with breast cancer patients evaluated for sarcopenia in relation to overall survival (OS), progression-free survival (PFS), relapse of disease (DFS), pathological complete response (pCR), or toxicity to chemotherapy were included. (3) Results: Out of 359 screened studies, 16 were eligible for meta-analysis, including 6130 patients, of whom 5284 with non-MBC. Sarcopenia was evaluated with the computed tomography (CT) scan skeletal muscle index and, in two studies, with the dual-energy x-ray absorptiometry (DEXA) appendicular lean mass index. Using different classifications and cut-off points, overall, there were 2007 sarcopenic patients (33%), of whom 1901 (95%) presented with non-MBC. Sarcopenia was associated with a 33% and 29% higher risk of mortality and progression/relapse of disease, respectively. Sarcopenic patients were more likely to develop grade 3-4 toxicity (OR 3.58, 95% CI 2.11-6.06, p < 0.0001). In the neoadjuvant setting, a higher rate of pCR was observed among sarcopenic patients (49%) (OR 2.74, 95% CI 0.92-8.22). (4) Conclusions: Our meta-analysis confirms the correlation between sarcopenia and negative outcomes, especially in terms of higher toxicity.
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Affiliation(s)
- Michela Roberto
- UOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I University Hospital, Sapienza University o f Rome, Viale Regina Elena, 324, 00161 Rome, Italy; (M.R.); (G.B.); (M.V.); (I.S.); (L.C.); (A.B.); (D.S.)
| | - Giacomo Barchiesi
- UOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I University Hospital, Sapienza University o f Rome, Viale Regina Elena, 324, 00161 Rome, Italy; (M.R.); (G.B.); (M.V.); (I.S.); (L.C.); (A.B.); (D.S.)
| | - Blerina Resuli
- Department of Medicine V, University Hospital Munich, Ziemssenstraße 5, 80336 Munich, Germany
| | - Monica Verrico
- UOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I University Hospital, Sapienza University o f Rome, Viale Regina Elena, 324, 00161 Rome, Italy; (M.R.); (G.B.); (M.V.); (I.S.); (L.C.); (A.B.); (D.S.)
| | - Iolanda Speranza
- UOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I University Hospital, Sapienza University o f Rome, Viale Regina Elena, 324, 00161 Rome, Italy; (M.R.); (G.B.); (M.V.); (I.S.); (L.C.); (A.B.); (D.S.)
| | - Leonardo Cristofani
- UOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I University Hospital, Sapienza University o f Rome, Viale Regina Elena, 324, 00161 Rome, Italy; (M.R.); (G.B.); (M.V.); (I.S.); (L.C.); (A.B.); (D.S.)
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy;
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy;
| | - Andrea Botticelli
- UOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I University Hospital, Sapienza University o f Rome, Viale Regina Elena, 324, 00161 Rome, Italy; (M.R.); (G.B.); (M.V.); (I.S.); (L.C.); (A.B.); (D.S.)
| | - Daniele Santini
- UOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I University Hospital, Sapienza University o f Rome, Viale Regina Elena, 324, 00161 Rome, Italy; (M.R.); (G.B.); (M.V.); (I.S.); (L.C.); (A.B.); (D.S.)
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Guo H, Lin XY, Feng S, Wang C, Yuan LQ, Sheng XG, Li DP. Prognostic value of obesity in patients with cancer treated with immune checkpoint inhibitors: An updated meta‑analysis and systematic review. Mol Clin Oncol 2024; 20:5. [PMID: 38125744 PMCID: PMC10729294 DOI: 10.3892/mco.2023.2703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/11/2023] [Indexed: 12/23/2023] Open
Abstract
Accumulating interest has been surging over the past few years regarding the effects of obesity on immunotherapy. In addition to the body mass index (BMI), imaging-quantified body fat compartments have been investigated. The present study aimed to evaluate the predictive value of the BMI and computed tomography (CT)-based body fat in patients with cancer receiving immunotherapy. For this purpose, the PubMed, MEDLINE, EMBASE and Cochrane databases were searched from January 2017 to July 2022. Clinical studies evaluating the association between BMI or body fat and survival of patients with cancer treated with immune checkpoint inhibitors (ICIs) were included. In total, 15 studies reporting on the BMI were included in the meta-analysis and 16 studies evaluating body fat were included in the systematic review. According to the classification of the World Health Organization, overweight and obese patients with ICI treatment showed improved overall survival [overweight vs. normal: Hazard ratio (HR)=0.79, 95% confidence interval (CI)=0.64-0.98, P=0.03; obese vs. normal: HR=0.75, 95% CI=0.60-0.94, P=0.013] and progression-free survival (overweight vs. normal: HR=0.82, 95% CI=0.70-0.97, P=0.02; obese vs. normal: HR=0.81, 95% CI=0.65-1.02, P=0.07). Among the articles investigating the effect of body fat composition on the efficacy of immunotherapy, a number of studies included various CT analysis techniques and cutoffs to define body fat composition. Associations of body fat with survival were contradictory in different patients with cancer treated with immunotherapy. Obesity was associated with better survival in patients with cancer treated with ICIs. Further analyses are required to demonstrate the prognostic value of body fat in patients with cancer immunotherapy.
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Affiliation(s)
- Hui Guo
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xue-Ying Lin
- Department of Surgery, Liaocheng Dongchangfu District Maternal and Child Health Hospital, Liaocheng, Shandong 252019, P.R. China
| | - Shuai Feng
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Cong Wang
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Ling-Qin Yuan
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xiu-Gui Sheng
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518116, P.R. China
| | - Da-Peng Li
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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Luo L, Shen X, Fang S, Wan T, Liu P, Li P, Tan H, Fu Y, Guo W, Tang X. Sarcopenia as a risk factor of progression-free survival in patients with metastases: a systematic review and meta-analysis. BMC Cancer 2023; 23:127. [PMID: 36750774 PMCID: PMC9906917 DOI: 10.1186/s12885-023-10582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Metastasis of cancer causes more than 90% of cancer deaths and is severely damaging to human health. In recent years, several studies have linked sarcopenia to shorter survival in patients with metastatic cancer. Several predictive models exist to predict mortality in patients with metastatic cancer, but have reported limited accuracy. METHODS We systematically searched Medline, EMBASE, and the Cochrane Library for articles published on or before October 14, 2022. Pooled Hazard Ratio (HR) estimates with 95% confidence intervals (CIs) were calculated using a random effects model. The primary outcome was an increased risk of death or tumor progression in patients with metastatic cancer, which is expressed as progression-free survival (PFS). In addition, we performed subgroup analyses and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results. RESULTS Sixteen retrospective cohort studies with 1,675 patients were included in the 888 papers screened. The results showed that sarcopenia was associated with lower progression-free survival (HR = 1.56, 95% CI = 1.19-2.03, I2 = 76.3%, P < 0.001). This result was further confirmed by trim-and-fill procedures and leave-one-out sensitivity analysis. CONCLUSIONS This study suggests that sarcopenia may be a risk factor for reduced progression-free survival in patients with metastatic cancer. Further studies are still needed to explain the reason for this high heterogeneity in outcome. TRIAL REGISTRATION CRD42022325910.
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Affiliation(s)
- Lingli Luo
- Medical College, Hunan Polytechnic of Environment and Biology, Hunan Province 421005 Hengyang, China
| | - Xiangru Shen
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Shuai Fang
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Teng Wan
- grid.33199.310000 0004 0368 7223Department of Neurology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518060 China
| | - Pan Liu
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Peiling Li
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Haifeng Tan
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Yong Fu
- grid.412017.10000 0001 0266 8918Department of Trauma Orthopaedic, The Second Affiliated Hospital, Hengyang Medical College, University of South China, Hengyang, 421001 Hunan China
| | - Weiming Guo
- grid.33199.310000 0004 0368 7223Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518060 China
| | - Xiaojun Tang
- The Second Affiliated Hospital, Department of Spinal Surgery, Hengyang Medical School, University of South China, Hunan, 421001, Hengyang, China.
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