A Nomogram Incorporating Intermuscular Adipose Tissue to Predict Chemotherapy Toxicity in Older Adults With Early-Stage Breast Cancer.

IF 2.2 4区医学 Q3 ONCOLOGY

Journal of Breast Cancer Pub Date : 2025-05-12 DOI:10.4048/jbc.2024.0194

Wen-Juan Huang, Han-Bing Xie, Lin Zhao, Rui-Han Zhou, Shurui Wang, Xin Zhang, Rui-Tao Wang, Zexun Duan

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引用次数: 0

Abstract

Purpose: Recent studies have shown that intermuscular adipose tissue (IMAT) is a significant prognostic factor for breast cancer. To date, no clinical studies have investigated whether IMAT can be used to predict chemotherapy toxicity in older adult patients with early-stage breast cancer.

Methods: We included 304 patients diagnosed with stage I-III breast cancer between January 2020 and December 2022 in Harbin Medical University Cancer Hospital. All patients were aged ≥ 65 years and treated with neoadjuvant or adjuvant chemotherapy. IMAT within the pectoralis muscle was measured using computed tomography imaging. Logistic regression analysis was used to identify independent predictors of chemotherapy toxicity. A nomogram was built, and the model performance was assessed using accuracy, discrimination, and clinical benefits. The net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to evaluate changes in model performance after the addition of adipose tissue.

Results: Of the 304 patients (184 in the training cohort and 120 in the validation cohort), 30.3% developed grade 3-5 chemotherapy toxicities. Three independent predictors were identified in the multivariate analysis: hemoglobin level, IMAT area, and primary prophylaxis with granulocyte colony-stimulating factor. The nomogram demonstrated area under the receiver operating characteristic curve values of 0.708 (95% confidence interval [CI], 0.616-0.801) and 0.751 (95% CI, 0.655-0.846) in the training and validation cohorts, respectively. The nomogram showed good calibration (Hosmer-Lemeshow test, p > 0.05), and incorporating IMAT improved nomogram performance in both cohorts (all NRI and IDI > 0, p < 0.05). Decision curve analysis revealed that the nomogram was clinically useful.

Conclusion: A nomogram including IMAT may be useful for predicting the individual probability of chemotherapy toxicity and guiding therapy in older adults with early-stage breast cancer.

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结合肌间脂肪组织的Nomogram预测老年早期乳腺癌患者化疗毒性。

目的：最近的研究表明，肌间脂肪组织（IMAT）是乳腺癌的一个重要预后因素。迄今为止，尚无临床研究调查IMAT是否可用于预测老年早期乳腺癌患者化疗毒性。方法：我们纳入了2020年1月至2022年12月在哈尔滨医科大学肿瘤医院诊断为I-III期乳腺癌的304例患者。所有患者年龄≥65岁，接受新辅助或辅助化疗。使用计算机断层成像测量胸肌内的IMAT。采用Logistic回归分析确定化疗毒性的独立预测因素。建立了一个nomogram，并通过准确性、辨别力和临床效益来评估模型的性能。采用净重分类指数（NRI）和综合识别改善指数（IDI）评价添加脂肪组织后模型性能的变化。结果：304例患者（184例训练组，120例验证组）中，30.3%出现3-5级化疗毒性。在多变量分析中确定了三个独立的预测因素：血红蛋白水平、IMAT面积和粒细胞集落刺激因子的初级预防。训练组和验证组的受试者工作特征曲线下面积分别为0.708（95%可信区间[CI]， 0.616-0.801）和0.751 （95% CI, 0.655-0.846）。nomogram显示出良好的校正效果（Hosmer-Lemeshow test, p < 0.05），合并IMAT改善了nomogram在两个队列中的表现（所有NRI和IDI > 0, p < 0.05）。决策曲线分析显示，该图具有临床应用价值。结论：包括IMAT在内的nomogram可用于预测老年早期乳腺癌患者化疗毒性的个体概率和指导治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Breast Cancer 医学-肿瘤学

CiteScore

3.80

自引率

4.20%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal of Breast Cancer (abbreviated as ''J Breast Cancer'') is the official journal of the Korean Breast Cancer Society, which is issued quarterly in the last day of March, June, September, and December each year since 1998. All the contents of the Journal is available online at the official journal website (http://ejbc.kr) under open access policy. The journal aims to provide a forum for the academic communication between medical doctors, basic science researchers, and health care professionals to be interested in breast cancer. To get this aim, we publish original investigations, review articles, brief communications including case reports, editorial opinions on the topics of importance to breast cancer, and welcome new research findings and epidemiological studies, especially when they contain a regional data to grab the international reader''s interest. Although the journal is mainly dealing with the issues of breast cancer, rare cases among benign breast diseases or evidence-based scientifically written articles providing useful information for clinical practice can be published as well.