Skip to main content

Advertisement

SpringerLink
Log in

Significance of skeletal muscle index-to-body mass index ratio as a predictor of post-surgical bleeding after mastectomy in patients with breast cancer

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Background

Post-surgical bleeding is a major complication of mastectomy in patients with breast cancer. However, the risk factors for post-surgical bleeding have not been well studied. Although obesity or reduced skeletal muscle mass is an indicator of cancer surgery complications, its impact on post-surgical bleeding after mastectomy remains unknown.

Methods

In total, 563 patients with breast cancer who underwent mastectomy were included in this study. We evaluated the preoperative body mass index (BMI), skeletal muscle index (SMI), and SMI-to-BMI ratio and analyzed the association between these values and the incidence of post-surgical bleeding.

Results

Post-surgical bleeding occurred in 33 (5.6%) patients. Mean BMI was significantly higher in the bleeding group (26.3 ± 4.7) than in the no-bleeding group (23.0 ± 4.1) (p < 0.001), whereas mean SMI was lower in the former group (45.0 ± 8.5) than in the latter group (48.0 ± 8.5) (p = 0.08). The bleeding group had significantly lower SMI-to-BMI ratio (1.71 ± 0.16) than the no-bleeding group (2.10 ± 0.23) (p < 0.001). Among these three parameters, SMI-to-BMI ratio had the highest area under the curve value in their receiver operating characteristic curves (0.73 for BMI, 0.59 for SMI, 0.92 for SMI-to-BMI ratio). Furthermore, on multivariate analysis, SMI-to-BMI ratio was an independent risk factor for post-surgical bleeding (hazard ratio, 38.4; 95% confidence interval, 13.9–136.2; p < 0.001).

Conclusions

SMI-to-BMI ratio is a superior predictive factor of post-surgical bleeding after mastectomy to either BMI or SMI alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data supporting the findings of this work are available from the authors upon reasonable request.

References

  1. Miller KD, Ortiz AP, Pinheiro PS, Bandi P, Minihan A, Fuchs HE, et al. Cancer statistics for the US hispanic/latino population, 2021. CA Cancer J Clin. 2021. https://doi.org/10.3322/caac.21695.

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32. https://doi.org/10.1056/NEJMoa020989.

    Article  PubMed  Google Scholar 

  3. Habermann EB, Abbott A, Parsons HM, Virnig BA, Al-Refaie WB, Tuttle TM. Are mastectomy rates really increasing in the United States? J Clin Oncol. 2010;28:3437–41. https://doi.org/10.1200/jco.2009.27.6774.

    Article  PubMed  Google Scholar 

  4. Pagliara D, Schiavone L, Garganese G, Bove S, Montella RA, Costantini M, et al. Predicting mastectomy skin flap necrosis: A systematic review of preoperative and intraoperative assessment techniques. Clin Breast Cancer. 2023. https://doi.org/10.1016/j.clbc.2022.12.021.

    Article  PubMed  Google Scholar 

  5. Olsen MA, Lefta M, Dietz JR, Brandt KE, Aft R, Matthews R, et al. Risk factors for surgical site infection after major breast operation. J Am Coll Surg. 2008;207:326–35. https://doi.org/10.1016/j.jamcollsurg.2008.04.021.

    Article  PubMed  PubMed Central  Google Scholar 

  6. El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245:665–71. https://doi.org/10.1097/01.sla.0000245833.48399.9a.

    Article  PubMed  PubMed Central  Google Scholar 

  7. de Blacam C, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, et al. High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg. 2012;255:551–5. https://doi.org/10.1097/SLA.0b013e318246c294.

    Article  PubMed  Google Scholar 

  8. Garland M, Hsu FC, Clark C, Chiba A, Howard-McNatt M. The impact of obesity on outcomes for patients undergoing mastectomy using the ACS-NSQIP data set. Breast Cancer Res Treat. 2018;168:723–6. https://doi.org/10.1007/s10549-017-4651-4.

    Article  PubMed  Google Scholar 

  9. Pastoriza J, McNelis J, Parsikia A, Lewis E, Ward M, Marini CP, et al. Predictive factors for surgical site infections in patients undergoing surgery for breast carcinoma. Am Surg. 2021;87:68–76. https://doi.org/10.1177/0003134820949996.

    Article  PubMed  Google Scholar 

  10. Wang M, Huang J, Chagpar AB. Do obese breast cancer patients have more complications and a longer length of stay after mastectomy than nonobese patients? Am Surg. 2021;87:1099–106. https://doi.org/10.1177/0003134820973352.

    Article  PubMed  Google Scholar 

  11. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. https://doi.org/10.1093/ageing/afy169.

    Article  PubMed  Google Scholar 

  12. Madariaga MLL, Troschel FM, Best TD, Knoll SJ, Gaissert HA, Fintelmann FJ. Low thoracic skeletal muscle area predicts morbidity after pneumonectomy for lung cancer. Ann Thorac Surg. 2020;109:907–13. https://doi.org/10.1016/j.athoracsur.2019.10.041.

    Article  PubMed  Google Scholar 

  13. Uehara H, Yamazaki T, Iwaya A, Kameyama H, Utsumi S, Harada R, et al. Is radiological psoas muscle area measurement a predictor of postoperative complications after rectal resection for rectal cancer? A retrospective study. Surg Today. 2021. https://doi.org/10.1007/s00595-021-02346-x.

    Article  PubMed  Google Scholar 

  14. Lodewick TM, Roeth AA, Olde Damink SW, Alizai PH, van Dam RM, Gassler N, et al. Sarcopenia, obesity and sarcopenic obesity: effects on liver function and volume in patients scheduled for major liver resection. J Cachexia Sarcopenia Muscle. 2015;6:155–63. https://doi.org/10.1002/jcsm.12018.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nishimura JM, Ansari AZ, D’Souza DM, Moffatt-Bruce SD, Merritt RE, Kneuertz PJ. Computed tomography-assessed skeletal muscle mass as a predictor of outcomes in lung cancer surgery. Ann Thorac Surg. 2019;108:1555–64. https://doi.org/10.1016/j.athoracsur.2019.04.090.

    Article  PubMed  Google Scholar 

  16. Kamarajah SK, Bundred J, Tan BHL. Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer. 2019;22:10–22. https://doi.org/10.1007/s10120-018-0882-2.

    Article  PubMed  Google Scholar 

  17. Baracos VE, Arribas L. Sarcopenic obesity: hidden muscle wasting and its impact for survival and complications of cancer therapy. Ann Oncol. 2018;29:1–9. https://doi.org/10.1093/annonc/mdx810.

    Article  Google Scholar 

  18. Kobayashi A, Kaido T, Hamaguchi Y, Okumura S, Shirai H, Yao S, et al. Impact of sarcopenic obesity on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg. 2019;269:924–31. https://doi.org/10.1097/sla.0000000000002555.

    Article  PubMed  Google Scholar 

  19. Mizuno S, Seishima R, Okabayashi K, Shigeta K, Matsui S, Kitagawa Y. Sarcopenic obesity is a postoperative prognostic factor for stage II and III colorectal cancer. J Gastrointest Surg. 2021;25:2951–3. https://doi.org/10.1007/s11605-021-04965-8.

    Article  PubMed  Google Scholar 

  20. Stangl-Kremser J, Mari A, Lai LY, Lee CT, Vince R, Zaslavsky A, et al. Sarcopenic obesity and its prognostic impact on urologic cancers: a systematic review. J Urol. 2021. https://doi.org/10.1097/ju.0000000000001873.

    Article  PubMed  Google Scholar 

  21. Winther Lietzen L, Cronin-Fenton D, Garne JP, Kroman N, Silliman R, Lash TL. Predictors of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study. Eur J Surg Oncol. 2012;38:407–12. https://doi.org/10.1016/j.ejso.2012.02.184.

    Article  CAS  PubMed  Google Scholar 

  22. Jochum SB, Kistner M, Wood EH, Hoscheit M, Nowak L, Poirier J, et al. Is sarcopenia a better predictor of complications than body mass index? Sarcopenia and surgical outcomes in patients with rectal cancer. Colorectal Dis. 2019;21:1372–8. https://doi.org/10.1111/codi.14751.

    Article  CAS  PubMed  Google Scholar 

  23. Matsui R, Inaki N, Tsuji T. Impact of preoperative muscle quality on postoperative severe complications after radical gastrectomy for gastric cancer patients. Ann Gastroenterol Surg. 2021;5:510–8. https://doi.org/10.1002/ags3.12452.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9:629–35. https://doi.org/10.1016/s1470-2045(08)70153-0.

    Article  PubMed  Google Scholar 

  25. Sun C, Anraku M, Kawahara T, Karasaki T, Kitano K, Nagayama K, et al. Respiratory strength and pectoralis muscle mass as measures of sarcopenia: Relation to outcomes in resected non-small cell lung cancer. J Thorac Cardiovasc Surg. 2022;163:779-87.e2. https://doi.org/10.1016/j.jtcvs.2020.10.133.

    Article  PubMed  Google Scholar 

  26. Go SI, Park MJ, Song HN, Kim HG, Kang MH, Kang JH, et al. A comparison of pectoralis versus lumbar skeletal muscle indices for defining sarcopenia in diffuse large B-cell lymphoma—two are better than one. Oncotarget. 2017;8:47007–19. https://doi.org/10.18632/oncotarget.16552.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rossi F, Lambertini M, Brunetti N, De Giorgis S, Razeti MG, Calabrese M, et al. Muscle mass loss in breast cancer patients of reproductive age (≤ 45 years) undergoing neoadjuvant chemotherapy. Radiol Med. 2023;128:49–57. https://doi.org/10.1007/s11547-022-01574-6.

    Article  PubMed  Google Scholar 

  28. Song HN, Kim JY, Kim JM, Kang KM, Choi HS, Jeong JH, et al. Sarcopenia using pectoralis muscle area and lymphocyte-to-monocyte ratio (LMR) are independent prognostic factors in patients for nonmetastatic breast cancer. Medicine (Baltimore). 2022;101:e32229. https://doi.org/10.1097/md.0000000000032229.

    Article  CAS  PubMed  Google Scholar 

  29. Seki T, Hayashida T, Takahashi M, Jinno H, Kitagawa Y. A randomized controlled study comparing a vessel sealing system with the conventional technique in axillary lymph node dissection for primary breast cancer. Springerplus. 2016;5:1004. https://doi.org/10.1186/s40064-016-2710-7.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Amitani M, Oba T, Kiyosawa N, Morikawa H, Chino T, Soma A, et al. Skeletal muscle loss during neoadjuvant chemotherapy predicts poor prognosis in patients with breast cancer. BMC Cancer. 2022;22:327. https://doi.org/10.1186/s12885-022-09443-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

This work was not funded by any grant.

Author information

Authors and Affiliations

  1. Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan

    Hiroki Morikawa, Takaaki Oba, Nami Kiyosawa, Ryoko Iji, Masatsugu Amitani, Tatsunori Chino, Tadafumi Shimizu, Mayu Ono, Tokiko Ito, Toshiharu Kanai, Kazuma Maeno & Ken-ichi Ito

Authors
  1. Hiroki Morikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takaaki Oba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nami Kiyosawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryoko Iji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masatsugu Amitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tatsunori Chino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tadafumi Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mayu Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tokiko Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshiharu Kanai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kazuma Maeno
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ken-ichi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HM and TO designed the study. NK, RI, MA, TC, TS, MO, TI, TK, KM collected the clinical data. HM and TO performed the statistical analysis. The draft manuscript was prepared by HM, TO and KI. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takaaki Oba.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morikawa, H., Oba, T., Kiyosawa, N. et al. Significance of skeletal muscle index-to-body mass index ratio as a predictor of post-surgical bleeding after mastectomy in patients with breast cancer. Breast Cancer 30, 933–942 (2023). https://doi.org/10.1007/s12282-023-01483-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-023-01483-0

Keywords

Search

Navigation