Impact of pectoralis muscle loss on cardiac outcome and survival in Cancer patients who received anthracycline based chemotherapy: retrospective study

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Abstract

Introduction: The impact of pectoralis muscle mass index (PMI) on cardiac events is not well studied in cancer patients, especially in those who have received chemotherapy with high potential cardiac toxicity such as anthracyclines. Methods: Individuals aged ≥18 years with a diagnosis of breast cancer, sarcoma, or lymphoma who received anthracycline-based chemotherapy at the University of Minnesota MHealth Fairview between 2009 and 2014. Eligible patients had to have two CT scans: a baseline CT scan within 6 months prior to chemotherapy and a follow-up CT scan within 2 years after treatment. The PMI was calculated as the right pectoralis muscle area indexed to height squared. Multivariable linear regression was used to analyze factors associated with PMI at follow-up, overall mortality, and major cardiac events (MACE). Results: A total of 474 patients (breast cancer 192; lymphoma 184; sarcoma 98) participated with a median age of 61 years at the time of baseline CT scan; 161 (34%) were male. Almost all patients received anthracyclines except 12% who received trastuzumab only. The median baseline PMI was 5.8 cm2/m2 (4.9, 7.7) which decreased 10.5% after chemotherapy, to 5.2 cm2/m2 (4.4, 6.4). Baseline PMI was not significantly associated with OS, but we detected lower risks of MACE with larger PMI at baseline. Greater baseline PMI was associated with greater follow-up PMI, but also with greater relative PMI loss. Female gender, older age, and history of smoking were also associated with greater PMI losses. Conclusion: Greater pre-treatment pectoralis muscle index in patients treated with anthracyclines have a lower risk of MACE. Early identification of sarcopenia using PMI could trigger proactive engagement for intervention and risk-stratified therapies.

Original languageEnglish (US)
Article number763
JournalBMC Cancer
Volume22
Issue number1
DOIs
StatePublished - Dec 2022

Bibliographical note

Funding Information:
All authors contributed to all aspects of the research, analysis, and manuscript preparation and have approved the final version. We are submitting our results from the analysis of data collected retrospectively of patients with breast cancer, sarcoma, or lymphoma who received anthracycline-based chemotherapy between 2009 and 2014 at the University of Minnesota MHealth Fairview. We investigated the impact of sarcopenia, using pectoralis muscle mass index (PMI) as a good surrogate, on cardiac events and survival in this cohort. In addition to studying of risk factors associated with muscle loss before and after chemotherapy. We detected lower risks of major cardiac events (MACE) with larger PMI before initiating chemotherapy. Furthermore, greater pre-treatment PMI was associated with greater post-treatment PMI, but also with greater relative PMI loss. Female gender, older age, and history of smoking were also associated with greater PMI losses. Early identification of sarcopenia using PMI could trigger future clinical trials that include proactive intervention and risk stratified therapies. https://coreslicer.com/ The need for informed consent was waived by the University of Minnesota Institutional Review Board (IRB) because the retrospective nature of the study. Research reported in this publication was supported by NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no other relevant financial or non-financial interests to disclose.

Funding Information:
Research reported in this publication was supported by NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no other relevant financial or non-financial interests to disclose.

Publisher Copyright:
© 2022, The Author(s).

Keywords

  • Breast cancer
  • Cardiac
  • Lymphoma
  • Sarcoma
  • Sarcopenia

PubMed: MeSH publication types

  • Journal Article

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