Background: The predictive value of muscle-related indicators in triple-negative breast cancer (TNBC) patients undergoing neoadjuvant chemotherapy (NAC) remains unclear. This study aimed to evaluate the association between the skeletal muscle density (SMD) and clinical variables related to the physical reserve with respect to its impact on the pathologic complete response (pCR).Methods: We retrospectively analyzed TNBC patients who underwent NAC at Seoul St. Mary’s Hospital, Catholic University of Korea, from March 2021 to March 2024, via receiving paclitaxel/carboplatin followed by doxorubicin/cyclophosphamide, with or without pembrolizumab. Muscle indices were assessed from CT measurements of the entire cross-sectional muscle area at the L3 level using commercial deep learning software (ClariMetabo version 1.03).Results: A total of 144 patients were included, where 102 received chemoimmunotherapy (NACIT) and 42 received chemotherapy alone (NACT). A higher SMD was significantly associated with a younger age, lower BMI, and fewer comorbidities. In the NACIT group, patients in the high-SMD group (n = 68) demonstrated a higher relative dose intensity (p= 0.003) and improved pCR rates (63.2% vs. 44.1%,p= 0.066) compared with the low-SMD group (n = 34). The multivariable regression analysis identified a higher SMD (per 5-unit increment: OR = 1.67,p= 0.003) and increased PD-L1 combined positive score (per 10-unit increment: OR = 1.38,p= 0.019) as independent predictors of a pCR. The event-free survival was significantly longer in the high-SMD group (p= 0.017) and among patients that achieved a pCR (p< 0.001). In the NACT group, the SMD was not associated with a pCR or survival.Conclusions: The CT-measured SMD reflected the physical reserve in the TNBC patients that received NAC. Alongside the CPS, SMD may serve as a predictive marker for NACIT efficacy.
背景：在三阴性乳腺癌（TNBC）患者接受新辅助化疗（NAC）过程中，肌肉相关指标的预测价值尚不明确。本研究旨在评估骨骼肌密度（SMD）及与生理储备相关的临床变量对病理完全缓解（pCR）的影响。 方法：我们回顾性分析了2021年3月至2024年3月在韩国天主教大学首尔圣母医院接受NAC的TNBC患者，治疗方案为紫杉醇/卡铂序贯多柔比星/环磷酰胺，联合或不联合帕博利珠单抗。采用商用深度学习软件（ClariMetabo 1.03版）通过CT测量L3水平横截面肌肉总面积来评估肌肉指标。 结果：共纳入144例患者，其中102例接受化疗免疫联合治疗（NACIT），42例接受单纯化疗（NACT）。较高的SMD与较年轻年龄、较低BMI及较少合并症显著相关。在NACIT组中，高SMD组患者（n=68）较低SMD组（n=34）显示出更高的相对剂量强度（p=0.003）和改善的pCR率（63.2% vs. 44.1%，p=0.066）。多变量回归分析显示，较高的SMD（每增加5单位：OR=1.67，p=0.003）和升高的PD-L1联合阳性评分（每增加10单位：OR=1.38，p=0.019）是pCR的独立预测因子。高SMD组（p=0.017）及达到pCR的患者（p<0.001）无事件生存期显著延长。在NACT组中，SMD与pCR或生存率无显著关联。 结论：CT测量的SMD反映了接受NAC的TNBC患者的生理储备状况。联合CPS评估时，SMD可作为预测NACIT疗效的生物标志物。
肿瘤(癌症)患者之家