人体脂肪重量影响乳腺癌化疗毒性
化疗初始剂量通常根据体表面积进行计划，而不考虑人体成分。
2018年10月22日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表荷兰瓦赫宁恩大学、安斐医院、圣卢卡斯安德烈亚斯医院、格尔德兰谷医院、马西玛医疗中心、圣安东尼医院、弗勒沃医院、亚历山大蒙罗医院、阿姆斯特丹自由大学、美国宾夕法尼亚州立大学的研究报告，分析了乳腺癌化疗患者脂肪重量（绝对重量kg、相对重量%）以及去脂重量（绝对重量kg、相对重量%）与毒性所致治疗调整之间的相关性。
该观察研究通过双能X射线扫描测定了172例I～IIIB期乳腺癌患者的人体成分，从医疗记录提取毒性所致治疗调整信息，定义为化疗的剂量减少、疗程推迟、方案转换、提前终止。计算校正风险比和95%置信区间，以评定人体成分与毒性所致治疗调整风险之间的相关性。
结果，其中95例患者（55%）发生毒性所致治疗调整：
脂肪绝对重量每增加5kg：毒性所致治疗调整风险增加14%（风险比：1.14，95%置信区间：1.04～1.25）
脂肪相对重量每增加5%：毒性所致治疗调整风险增加21%（风险比：1.21，95%置信区间：1.05～1.38）
去脂绝对重量每增加5kg：毒性所致治疗调整风险相似（风险比：1.07，95%置信区间：0.92～1.27）
去脂相对重量每增加5%：毒性所致治疗调整风险减少17%（风险比：0.83，95%置信区间：0.72～0.96）
因此，该研究结果表明，人体脂肪的绝对重量和相对重量，与化疗毒性所致治疗调整风险增加相关。去脂绝对重量与化疗毒性所致治疗调整风险无关，而去脂相对重量较高与化疗毒性所致治疗调整风险较低相关。乳腺癌患者的脂肪重量，是化疗期间毒性风险的重要决定因素。
Breast Cancer Res Treat. 2018 Oct 23. [Epub ahead of print]
Body composition is associated with risk of toxicity-induced modifications of treatment in women with stage I-IIIB breast cancer receiving chemotherapy.
Maaike M. G. A. van den Berg, Dieuwertje E. Kok, Liesbeth Posthuma, Lisette Kamps, Celine S. Kelfkens, Nicole Buist, Maud Geenen, Annebeth Haringhuizen, Joan B. Heijns, Rianne H. M. A. van Lieshout, Maartje Los, Dirkje W. Sommeijer, Johanna N. H. Timmer-Bonte, Anja Th. C. M. de Kruif, Hanneke W. M. van Laarhoven, Ellen Kampman, Renate M. Winkels.
Wageningen University & Research, Wageningen, The Netherlands; Amphia Ziekenhuis, Breda, The Netherlands; Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands; Ziekenhuis Gelderse Vallei, Ede, The Netherlands; Máxima Medical Centre, Eindhoven, The Netherlands; St Antonius Ziekenhuis, Nieuwegein, The Netherlands; Flevoziekenhuis, Almere, The Netherlands; Alexander Monro Ziekenhuis, Bilthoven, The Netherlands; VU University, Amsterdam, The Netherlands; Academic Medical Center, Amsterdam, The Netherlands; Penn State College of Medicine, Hershey, USA.
PURPOSE: Initial dose of chemotherapy is planned based on body surface area, which does not take body composition into account. We studied the association between fat mass (kg and relative to total body weight) as well as lean mass (kg and relative to total body weight) and toxicity-induced modifications of treatment in breast cancer patients receiving chemotherapy.
METHODS: In an observational study among 172 breast cancer patients (stage I-IIIB) in the Netherlands, we assessed body composition using dual-energy X-ray scans. Information on toxicity-induced modifications of treatment, defined as dose reductions, cycle delays, regimen switches, or premature termination of chemotherapy, was abstracted from medical records. Adjusted hazard ratios and 95% confidence intervals (95% CI) were calculated to assess associations between body composition and the risk of toxicity-induced modifications of treatment.
RESULTS: In total, 95 out of 172 (55%) patients experienced toxicity-induced modifications of treatment. Higher absolute and relative fat mass were associated with higher risk of these modifications (HR 1.14 per 5 kg; 95% CI 1.04-1.25 and HR 1.21 per 5%; 95% CI 1.05-1.38, respectively). A higher relative lean mass was associated with a lower risk of modifications (HR 0.83 per 5%; 95% CI 0.72-0.96). There was no association between absolute lean mass and risk of toxicity-induced modifications of treatment.
CONCLUSIONS: A higher absolute and a higher relative fat mass was associated with an increased risk of toxicity-induced modifications of treatment. Absolute lean mass was not associated with risk of these treatment modifications, while higher relative lean mass associated with lower risk of modifications. These data suggest that total fat mass importantly determines the risk of toxicities during chemotherapy in breast cancer patients.
KEYWORDS: Chemotherapy Toxicity Breast cancer Body composition Fat mass
DOI: 10.1007/s10549-018-5014-5