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Comment & Response
January 2019

Body Composition and Overall Survival in Patients With Nonmetastatic Breast Cancer

Author Affiliations
  • 1Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 2Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut
JAMA Oncol. 2019;5(1):114-115. doi:10.1001/jamaoncol.2018.5290

To the Editor Caan et al1 conducted an interesting study to evaluate the associations of 3 body composition measures with overall survival (OS) in patients with nonmetastatic breast cancer. Comparing patients with and without sarcopenia, the authors report a hazard ratio (HR) of 1.41 (95% CI, 1.18-1.69). Although a statistically significant association between sarcopenia and OS was established, a 40% increase in the HR for sarcopenia is difficult to interpret clinically. The hazard cannot be interpreted as a risk (ie, the chance or likelihood of an event occurring). Moreover, without the background hazard function as a benchmark in patients without sarcopenia, a 40% increase might not amount to a clinically meaningful difference.2 Furthermore, when the HR is not constant over time, it is unclear how to interpret the observed HR.3