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Myosteatosis evaluation using erector spinae and psoas muscles to predict adverse events during adjuvant chemotherapy for breast cancer

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Abstract

Background

Myosteatosis (intramuscular adiposity) is predictive of chemotherapy toxicity in women undergoing adjuvant chemotherapy for breast cancer (BC). We evaluated a novel, user-friendly and cost-effective technique utilizing a Picture Archiving and Communication Systems (PACS) tool that is readily available in the electronic medical record (EMR), using skeletal muscle density (SMD) to detect myosteatosis and then compared PACS results with those derived from widely used body composition software (SliceOMatic, QC, Canada).

Methods

Using retrospective data from a sample of women with early BC (Stage I-III) who had CT scan and received chemotherapy. Pearson correlation coefficients were used to compare SliceOMatic with PACS results. Associations of PACS results with chemotherapy-related adverse events were evaluated using multivariable (MV) log-binomial models adjusted for age, race, BMI, anthracycline-based therapy, and number of comorbidities.

Results

In 338 patients, mean age was 51, 32% were non-white, and 40% had obesity (BMI ≥ 30 kg/m2). Correlation of SMD using SliceOMatic whole muscle measurements with PACS psoas muscle was 0.76 (p < .0001) and with PACS erector spinae muscle 0.91 (p < .0001). Using PACS psoas muscle, myosteatosis was associated with any adverse event [RR 1.66, CI 1.22–2.26 (p < .0001)], dose reduction [RR 1.63, CI 1.01–2.65 (p = .05)], and early treatment discontinuation [RR 2.14, CI 1.10–4.14 (p = 0.03)]. Using PACS erector spinae muscle, myosteatosis was associated any adverse event [RR 1.59, CI 1.11–2.27 (p = 0.01)] and dose reduction [RR 1.91, CI 1.07–3.42 (p = .03)].

Conclusion and relevance

Skeletal muscle density measures using PACS correlated strongly with SliceOMatic results and both are similarly predictive of chemotherapy-related adverse events

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Abbreviations

CT:

Computed tomography

DICOM:

Digital imaging and communications in medicine

SMD:

Skeletal muscle density

HU:

Hounsfield units

PACS:

Picture Archiving and Communication System

EMR:

Electronic medical record

EBC:

Early breast cancer

ROI:

Region of interest

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Acknowledgements

We greatly appreciate the active support of oncology clinicians and their research staff at multiple sites and, most importantly, the breast cancer patients participating in our study. We thank Tucker Brenizer, Shanah R. Kirk, and Amy Garrett for their commitment to study implementation best practices.

Funding

This study was supported by the Breast Cancer Research Foundation (New York), UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund, and Kay Yow Fund (Raleigh, North Carolina).

Author information

Authors and Affiliations

  1. Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    G. F. P. Aleixo, K. A. Nyrop & H. B. Muss

  2. Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA

    G. F. P. Aleixo

  3. Division of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    H. Yu

  4. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Y. T. Chen

  5. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    K. A. Nyrop, A. M. Deal & H. B. Muss

  6. Ruth and Bruce Rappaport Faculty of Medicine at Technion, Haifa, Israel

    S. S. Shachar

  7. Division of Hematology/Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA

    G. R. Williams

  8. Division of Surgical Oncology Endocrine Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    R. J. Louie

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  1. G. F. P. Aleixo
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  2. H. Yu
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Corresponding author

Correspondence to G. F. P. Aleixo.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individuals participants in this study and approved by the IRB of the University of North Carolina at Chapel Hill.

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Aleixo, G.F.P., Yu, H., Chen, Y.T. et al. Myosteatosis evaluation using erector spinae and psoas muscles to predict adverse events during adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 186, 487–495 (2021). https://doi.org/10.1007/s10549-020-06061-y

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