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Association of body composition and surgical outcomes in patients with early-stage breast cancer

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Abstract

Background

Breast cancer is a disease that requires multimodality treatment, and surgical resection of the tumor is a critical component of curative intent treatment. Obesity, defined as a body mass index (BMI) > 30, has been associated with increased surgical complications. Additionally, sarcopenia, a condition of gradual loss of muscle mass, has been associated with worse breast cancer treatment outcomes. Sarcopenia occurs with increased age, inactivity, and poor diet leading to patient frailty, which can increase medical treatment complications. Even patients with high BMI can have sarcopenia (termed sarcopenic obesity). We investigated the association of sarcopenia with surgical complications for breast cancer.

Methods

A retrospective review was performed of patients diagnosed with breast cancer who received bioelectrical impedance spectrometry analysis of skeletal muscle mass and had surgery at our institution. Patient characteristics, treatment data, surgical type and complications were obtained from medical records. Multivariate logistic regression models were used to associate sarcopenia status and BMI with surgical complications, adjusted for other patient characteristics.

Results

We analyzed 682 patients with stage I to III breast cancer. On multivariable logistic regression controlling for age, BMI, comorbidities, and types of surgeries (lumpectomy, mastectomy with or without reconstruction), sarcopenia (p = 0.66) was not associated with surgical complications. Obesity was associated with a higher rate of surgical complications in patients who received mastectomy with reconstruction (p = 0.01). More complex surgical approaches were associated with a higher risk of surgical complications in our series.

Conclusion

Compared with those undergoing lumpectomy or mastectomy without reconstruction, patients undergoing mastectomy with reconstruction were more likely to experience postoperative complications and obesity was associated with higher risk of complication in the latter group. We did not identify a correlation between sarcopenia and rate of adverse surgical outcomes.

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Data Availability

the datasets generated during and/or analyzed during the current study are not publicly available due to confidentiality reasons but are available from the corresponding author on reasonable request.

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Acknowledgments

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Funding

Not applicable Notes Funding Financial interests: all authors declare they have no financial interests to report.

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Authors and Affiliations

  1. Department of internal medicine, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Gabriel Francisco Pereira Aleixo

  2. Department of Surgery, Division of Breast Surgery, Cleveland Clinic OH, Cleveland, USA

    Stephanie A. Valente

  3. Department of Biostatistics, Cleveland Clinic OH, Cleveland, USA

    Wei Wei

  4. Taussig Cancer Center, Cleveland Clinic OH, Cleveland, USA

    Halle C.F. Moore

Authors
  1. Gabriel Francisco Pereira Aleixo
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  2. Stephanie A. Valente
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  4. Halle C.F. Moore
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Contributions

GFPA– conceptualization, data curation, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing the original draft and writing review and editing.

SAV–conceptualization, investigation, methodology, project administration, software, supervision, validation, visualization, writing to review and editing.

WW– formal analysis and writing review and editing.

HCFM– conceptualization, data curation, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing the original draft and writing review and editing.

Corresponding author

Correspondence to Gabriel Francisco Pereira Aleixo.

Ethics declarations

Conflict of interest

Dr. Stephanie Valente is a consultant for ImpediMed, Pacira, AxoGen, and Merit Medical. Dr. Halle Moore reports consulting fees from Myovant and grants or contracts to her institution from AstraZeneca, Roche/Genentech, Daiichi-Sankyo, Sermonix, and Seattle Genetics. All other authors have no conflict of interest to report.

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Disclosures

GFPA - No disclosures to report.

SAV- serves as consultant for SOZO.

WW- No disclosures to report.

HCFM- reports grants or contracts received by AstraZeneca, Roche/Genetech, Daiichi-Sankyo, Sermonix, Seattle genetics.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Cleveland Clinic Consent to participate.

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Informed consent was not needed due to observational characteristic of the study.

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Aleixo, G.F.P., Valente, S.A., Wei, W. et al. Association of body composition and surgical outcomes in patients with early-stage breast cancer. Breast Cancer Res Treat 202, 305–311 (2023). https://doi.org/10.1007/s10549-023-07060-5

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  • DOI: https://doi.org/10.1007/s10549-023-07060-5

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