Abstract：
BACKGROUND: Malnutrition and sarcopenia are challenges for patients with metastatic breast cancer and have been proposed as independent prognostic factors. Very few studies have addressed the temporal evolution of these parameters and, notably, the separate and combined analysis of sarcopenia and malnutrition. This study aimed to i) determine the prevalence of malnutrition and sarcopenia, individually and combined, and their evolution over time, ii) identify risk factors for each condition, and iii) explore their impact on overall survival (OS).
METHODS: This retrospective study was conducted on 111 patients treated for at least a third-line metastatic breast cancer at the Institut Curie between January 1st and March 31st, 2018. Solitary malnutrition was defined from weight loss and body mass index values while solitary sarcopenia was defined solely based on low muscle mass. We analyzed solitary malnutrition, solitary sarcopenia, and then malnutrition with or without sarcopenia, at three key stages (T1: diagnosis of metastasis, T2: initiation of third-line treatment, and T3: 3-month re-evaluation). Univariate and multivariate logistic regression analyses were conducted to investigate the risk factors. We performed Cox proportional hazards analyses for each variable.
RESULTS: At T1, the prevalence of solitary malnutrition, solitary sarcopenia and malnutrition with or without sarcopenia was 18.6%, 36.1% and 48.9% respectively, increasing to 27.7%, 45.5% and 56.6% at T2. At T2, in multivariate logistic regression analyses, patients aged over 60 years were at an elevated risk of experiencing solitary malnutrition as well as malnutrition with or without sarcopenia, but not solitary sarcopenia. In multivariate analyses, solitary malnutrition was significantly associated with poorer OS (HR 2.2 [95% CI 1.1-4.1], p = 0.02), while solitary sarcopenia and malnutrition with or without sarcopenia showed no association.
CONCLUSIONS: Solitary malnutrition and sarcopenia were highly prevalent in patients with metastatic breast cancer, affecting around a quarter and half of patients respectively at third-line treatment initiation. Notably, solitary malnutrition emerged as a prognostic factor for overall survival, whereas no significant association was observed for solitary sarcopenia or malnutrition with or without sarcopenia. This highlights the critical need for early identification of patients at risk of malnutrition and the importance of timely intervention.
METHODS: This retrospective study was conducted on 111 patients treated for at least a third-line metastatic breast cancer at the Institut Curie between January 1st and March 31st, 2018. Solitary malnutrition was defined from weight loss and body mass index values while solitary sarcopenia was defined solely based on low muscle mass. We analyzed solitary malnutrition, solitary sarcopenia, and then malnutrition with or without sarcopenia, at three key stages (T1: diagnosis of metastasis, T2: initiation of third-line treatment, and T3: 3-month re-evaluation). Univariate and multivariate logistic regression analyses were conducted to investigate the risk factors. We performed Cox proportional hazards analyses for each variable.
RESULTS: At T1, the prevalence of solitary malnutrition, solitary sarcopenia and malnutrition with or without sarcopenia was 18.6%, 36.1% and 48.9% respectively, increasing to 27.7%, 45.5% and 56.6% at T2. At T2, in multivariate logistic regression analyses, patients aged over 60 years were at an elevated risk of experiencing solitary malnutrition as well as malnutrition with or without sarcopenia, but not solitary sarcopenia. In multivariate analyses, solitary malnutrition was significantly associated with poorer OS (HR 2.2 [95% CI 1.1-4.1], p = 0.02), while solitary sarcopenia and malnutrition with or without sarcopenia showed no association.
CONCLUSIONS: Solitary malnutrition and sarcopenia were highly prevalent in patients with metastatic breast cancer, affecting around a quarter and half of patients respectively at third-line treatment initiation. Notably, solitary malnutrition emerged as a prognostic factor for overall survival, whereas no significant association was observed for solitary sarcopenia or malnutrition with or without sarcopenia. This highlights the critical need for early identification of patients at risk of malnutrition and the importance of timely intervention.
摘要：
背景：营养不良和少肌症是转移性乳腺癌患者面临的挑战，并被认为是独立的预后因素。很少有研究解决这些参数的时间演变，特别是,肌少症和营养不良的单独和合并分析。这项研究旨在i)确定营养不良和肌少症的患病率，单独和组合，以及它们随着时间的演变，ii)确定每种情况的风险因素，和iii)探讨它们对总生存期(OS)的影响。
方法：这项回顾性研究是对1月1日至3月31日在居里研究所接受至少三线治疗的111例转移性乳腺癌患者进行的。2018.孤立性营养不良是根据体重减轻和体重指数值定义的，而孤立性肌肉减少症仅是根据低肌肉质量定义的。我们分析了孤独的营养不良，孤立性肌肉减少症,然后营养不良有或没有肌肉减少症，在三个关键阶段(T1：转移诊断，T2：开始三线治疗，和T3：3个月的重新评估）。采用单因素和多因素logistic回归分析探讨危险因素。我们对每个变量进行了Cox比例风险分析。
结果：在T1，孤立性营养不良的患病率，孤立性肌肉减少症和营养不良伴或不伴肌肉减少症的占18.6%，分别为36.1%和48.9%，增加到27.7%，T2时的45.5%和56.6%。在T2时，在多变量逻辑回归分析中，60岁以上的患者患孤立性营养不良以及伴有或不伴有肌少症的营养不良的风险较高，但不是孤立的肌少症.在多变量分析中，孤立性营养不良与OS较差显著相关(HR2.2[95%CI1.1-4.1]，p=0.02),而孤立性肌肉减少症和营养不良伴或不伴肌肉减少症没有相关性。
结论：孤立性营养不良和肌少症在转移性乳腺癌患者中非常普遍，在三线治疗开始时分别影响约四分之一和一半的患者。值得注意的是,孤立性营养不良成为总体生存的预后因素，而孤立性肌肉减少症或营养不良伴或不伴肌肉减少症没有观察到显著关联。这凸显了早期识别营养不良风险患者的迫切需要以及及时干预的重要性。
方法：这项回顾性研究是对1月1日至3月31日在居里研究所接受至少三线治疗的111例转移性乳腺癌患者进行的。2018.孤立性营养不良是根据体重减轻和体重指数值定义的，而孤立性肌肉减少症仅是根据低肌肉质量定义的。我们分析了孤独的营养不良，孤立性肌肉减少症,然后营养不良有或没有肌肉减少症，在三个关键阶段(T1：转移诊断，T2：开始三线治疗，和T3：3个月的重新评估）。采用单因素和多因素logistic回归分析探讨危险因素。我们对每个变量进行了Cox比例风险分析。
结果：在T1，孤立性营养不良的患病率，孤立性肌肉减少症和营养不良伴或不伴肌肉减少症的占18.6%，分别为36.1%和48.9%，增加到27.7%，T2时的45.5%和56.6%。在T2时，在多变量逻辑回归分析中，60岁以上的患者患孤立性营养不良以及伴有或不伴有肌少症的营养不良的风险较高，但不是孤立的肌少症.在多变量分析中，孤立性营养不良与OS较差显著相关(HR2.2[95%CI1.1-4.1]，p=0.02),而孤立性肌肉减少症和营养不良伴或不伴肌肉减少症没有相关性。
结论：孤立性营养不良和肌少症在转移性乳腺癌患者中非常普遍，在三线治疗开始时分别影响约四分之一和一半的患者。值得注意的是,孤立性营养不良成为总体生存的预后因素，而孤立性肌肉减少症或营养不良伴或不伴肌肉减少症没有观察到显著关联。这凸显了早期识别营养不良风险患者的迫切需要以及及时干预的重要性。
