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Original Investigation
April 5, 2018

Association of Muscle and Adiposity Measured by Computed Tomography With Survival in Patients With Nonmetastatic Breast Cancer

Author Affiliations
  • 1Division of Research, Kaiser Permanente, Oakland, California
  • 2Department of Agricultural, Food and Nutritional Sciences, 410 Agriculture/Forestry Centre University of Alberta, Edmonton, Alberta, Canada
  • 3Dana Farber Cancer Institute, Boston, Massachusetts
JAMA Oncol. Published online April 5, 2018. doi:10.1001/jamaoncol.2018.0137
Key Points

Question  Are sarcopenia, poor muscle quality, and excess adiposity at diagnosis associated with overall mortality in patients with nonmetastatic breast cancer?

Findings  In this observational study of 3241 patients with breast cancer, more than one-third presented with sarcopenia at diagnosis, and those women had a significantly increased risk of death compared with patients without sarcopenia. Poor muscle quality was not associated with survival, and highest mortality was in patients with sarcopenia and high total adipose tissue.

Meaning  Measures of sarcopenia provide significant prognostic information in nonmetastatic breast cancer and will help to identify high-risk groups and guide interventions to optimize survival outcomes.


Importance  Sarcopenia (low muscle mass), poor muscle quality (low muscle radiodensity), and excess adiposity derived from computed tomography (CT) has been related to higher mortality in patients with metastatic breast cancer, but the association with prognosis in patients with nonmetastatic breast cancer is unknown.

Objective  To evaluate associations of all 3 body composition measures, derived from clinically acquired CT at diagnosis, with overall mortality in nonmetastatic breast cancer.

Design, Setting, and Participants  This observational study included 3241 women from Kaiser Permanente of Northern California and Dana Farber Cancer Institute diagnosed from January 2000 to December 2013 with stages II or III breast cancer. We calculated hazard ratios (HRs) to evaluate the associations of all-cause mortality with sarcopenia, low muscle radiodensity, and total adipose tissue (TAT). Models were adjusted for sociodemographics, tumor characteristics, treatment, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and other body composition measures. We also evaluated the cross-classification of categories of sarcopenia (yes/no) and tertiles of TAT, with outcomes.

Main Outcomes and Measures  Overall survival time and all-cause mortality.

Results  Median (range) age of 3241 women included in this study was 54 (18-80) years, and median follow-up was 6.0 years; 1086 patients (34%) presented with sarcopenia, and 1199 patients (37%) had low muscle radiodensity. Among patients with nonmetastatic breast cancer, those with sarcopenia showed higher overall mortality (HR, 1.41; 95% CI, 1.18-1.69) compared with those without sarcopenia. Patients in the highest tertile of TAT also showed higher overall mortality (HR, 1.35; 95% CI, 1.08-1.69) compared with those in the lowest tertile. Low radiodensity was not associated with survival. In analyses of sarcopenia and TAT, highest mortality was seen in patients with sarcopenia and high TAT (HR, 1.89; 95% CI, 1.30-2.73); BMI alone was not significantly related to overall mortality and did not appropriately identify patients at risk of death owing to their body composition.

Conclusions and Relevance  Sarcopenia is underrecognized in nonmetastatic breast cancer and occurs in over one-third of newly diagnosed patients. Measures of both sarcopenia and adiposity from clinically acquired CT scans in nonmetastatic patients provide significant prognostic information that outperform BMI and will help to guide interventions to optimize survival outcomes.