Adipose Tissue Distribution and Survival Among Women with Nonmetastatic Breast Cancer

Overview

Journal Obesity (Silver Spring)

Specialties Endocrinology
Nutritional Sciences
Physiology

Date 2019 Apr 26

PMID 31021535

Citations 21

Authors

Patrick T Bradshaw

Elizabeth M Cespedes Feliciano

Carla M Prado

Stacey Alexeeff

Kathleen B Albers

Wendy Y Chen

Bette J Caan

Affiliations

Soon will be listed here.

Abstract

Objective: Previous studies of breast cancer survival have not considered specific depots of adipose tissue such as subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT).

Methods: This study assessed these relationships among 3,235 women with stage II and III breast cancer diagnosed between 2005 and 2013 at Kaiser Permanente Northern California and between 2000 and 2012 at Dana Farber Cancer Institute. SAT and VAT areas (in centimeters squared) were calculated from routine computed tomography scans within 6 (median: 1.2) months of diagnosis, covariates were collected from electronic health records, and vital status was assessed by death records. Hazard ratios (HRs) and 95% CIs were estimated using Cox regression.

Results: SAT and VAT ranged from 19.0 to 891 cm and from 0.484 to 454 cm , respectively. SAT was related to increased risk of death (127-cm increase; HR [95% CI]: 1.13 [1.02-1.26]), but no relationship was found with VAT (78.18-cm increase; HR [95% CI]: 1.02 [0.91-1.14]). An association with VAT was noted among women with stage II cancer (stage II: HR: 1.17 [95% CI: 0.99-1.39]; stage III: HR: 0.90 [95% CI: 0.76-1.07]; P interaction < 0.01). Joint increases in SAT and VAT were associated with mortality above either alone (simultaneous 1-SD increase: HR 1.19 [95% CI: 1.05-1.34]).

Conclusions: SAT may be an underappreciated risk factor for breast cancer-related death.

Citing Articles

Body composition as a potential biomarker of recurrence risk in patients with triple-negative breast cancer.

De Vis J, Wang C, Nguyen K, Sun L, Jia B, Sherry A Breast Cancer Res Treat. 2025; .

PMID: 40067427 DOI: 10.1007/s10549-025-07675-w.

Association of skeletal muscle quantity and quality with mortality in women with nonmetastatic breast cancer.

Mialich M, da Silva B, Amstalden B, Elias Jr J, Jordao A Discov Oncol. 2025; 16(1):247.

PMID: 40014176 PMC: 11867992. DOI: 10.1007/s12672-025-01999-1.

Abdominal visceral and subcutaneous adipose tissue associations with postmenopausal breast cancer incidence.

Bea J, Ochs-Balcom H, Valencia C, Chen Z, Blew R, Lind K JNCI Cancer Spectr. 2025; 9(1).

PMID: 39847539 PMC: 11879126. DOI: 10.1093/jncics/pkaf007.

The role of body composition in neurological and hematologic toxicity in a retrospective analysis of 120 breast cancer patients undergoing neoadjuvant chemotherapy: the COMBOTOX study.

Di Leone A, Filippone A, Maggiore C, Rossi M, Rossi C, Di Micco A Breast Cancer Res Treat. 2024; 210(1):205-213.

PMID: 39630164 PMC: 11787179. DOI: 10.1007/s10549-024-07553-x.

Prognostic value of body composition measures in breast cancer patients treated with chemotherapy.

Kang H, Kim I, Park H, Ahn W, Kim S, Lee S Sci Rep. 2024; 14(1):23309.

PMID: 39375403 PMC: 11458607. DOI: 10.1038/s41598-024-74060-w.

References

Ebadi M, Martin L, Ghosh S, Field C, Lehner R, Baracos V . Subcutaneous adiposity is an independent predictor of mortality in cancer patients. Br J Cancer. 2017; 117(1):148-155. PMC: 5520211. DOI: 10.1038/bjc.2017.149. View

Despres J, Lemieux I . Abdominal obesity and metabolic syndrome. Nature. 2006; 444(7121):881-7. DOI: 10.1038/nature05488. View

Witte J, Greenland S . A nested approach to evaluating dose-response and trend. Ann Epidemiol. 1997; 7(3):188-93. DOI: 10.1016/s1047-2797(96)00159-7. View

Snijder M, van Dam R, Visser M, Seidell J . What aspects of body fat are particularly hazardous and how do we measure them?. Int J Epidemiol. 2005; 35(1):83-92. DOI: 10.1093/ije/dyi253. View

Wajchenberg B . Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2001; 21(6):697-738. DOI: 10.1210/edrv.21.6.0415. View

Demark-Wahnefried W, Platz E, Ligibel J, Blair C, Courneya K, Meyerhardt J . The role of obesity in cancer survival and recurrence. Cancer Epidemiol Biomarkers Prev. 2012; 21(8):1244-59. PMC: 3415558. DOI: 10.1158/1055-9965.EPI-12-0485. View

Prado C, Gonzalez M, Heymsfield S . Body composition phenotypes and obesity paradox. Curr Opin Clin Nutr Metab Care. 2015; 18(6):535-51. DOI: 10.1097/MCO.0000000000000216. View

George S, Bernstein L, Smith A, Neuhouser M, Baumgartner K, Baumgartner R . Central adiposity after breast cancer diagnosis is related to mortality in the Health, Eating, Activity, and Lifestyle study. Breast Cancer Res Treat. 2014; 146(3):647-55. PMC: 6996589. DOI: 10.1007/s10549-014-3048-x. View

Iyengar N, Hudis C, Dannenberg A . Obesity and cancer: local and systemic mechanisms. Annu Rev Med. 2015; 66:297-309. DOI: 10.1146/annurev-med-050913-022228. View

10.

Smith S, Lovejoy J, Greenway F, Ryan D, DeJonge L, de la Bretonne J . Contributions of total body fat, abdominal subcutaneous adipose tissue compartments, and visceral adipose tissue to the metabolic complications of obesity. Metabolism. 2001; 50(4):425-35. DOI: 10.1053/meta.2001.21693. View

11.

Katzmarzyk P, Heymsfield S, Bouchard C . Clinical utility of visceral adipose tissue for the identification of cardiometabolic risk in white and African American adults. Am J Clin Nutr. 2013; 97(3):480-6. PMC: 3578400. DOI: 10.3945/ajcn.112.047787. View

12.

Srikanthan P, Karlamangla A . Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third National Health and Nutrition Examination Survey. J Clin Endocrinol Metab. 2011; 96(9):2898-903. DOI: 10.1210/jc.2011-0435. View

13.

Tran T, Yamamoto Y, Gesta S, Kahn C . Beneficial effects of subcutaneous fat transplantation on metabolism. Cell Metab. 2008; 7(5):410-20. PMC: 3204870. DOI: 10.1016/j.cmet.2008.04.004. View

14.

Sun X, Nichols H, Robinson W, Sherman M, Olshan A, Troester M . Post-diagnosis adiposity and survival among breast cancer patients: influence of breast cancer subtype. Cancer Causes Control. 2015; 26(12):1803-11. PMC: 5057532. DOI: 10.1007/s10552-015-0673-6. View

15.

Janiszewski P, Saunders T, Ross R . Breast volume is an independent predictor of visceral and ectopic fat in premenopausal women. Obesity (Silver Spring). 2009; 18(6):1183-7. DOI: 10.1038/oby.2009.336. View

16.

Mourtzakis M, Prado C, Lieffers J, Reiman T, McCargar L, Baracos V . A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008; 33(5):997-1006. DOI: 10.1139/H08-075. View

17.

Monzon J, Basile R, Heneghan S, Udupi V, Green A . Lipolysis in adipocytes isolated from deep and superficial subcutaneous adipose tissue. Obes Res. 2002; 10(4):266-9. DOI: 10.1038/oby.2002.36. View

18.

Patterson R, Cadmus L, Emond J, Pierce J . Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010; 66(1):5-15. DOI: 10.1016/j.maturitas.2010.01.004. View

19.

Renehan A, Zwahlen M, Egger M . Adiposity and cancer risk: new mechanistic insights from epidemiology. Nat Rev Cancer. 2015; 15(8):484-98. DOI: 10.1038/nrc3967. View

20.

Prado C, Heymsfield S . Lean tissue imaging: a new era for nutritional assessment and intervention. JPEN J Parenter Enteral Nutr. 2014; 38(8):940-53. PMC: 4361695. DOI: 10.1177/0148607114550189. View