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Predictive Value of CT-Derived Skeletal Muscle Metrics for Pathologic Complete Response in Breast Cancer Patients
Günay Rona1, Ayşe Özdal Sayer1, Sedat Yıldırım2
1Department of Radiology, University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye.
Objective:
To investigate the predictive value of computed tomography (CT)-derived body composition parameters for pathological complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy (NAC).
Materials And Methods:
Female patients who received NAC between January 2010 and December 2022 were retrospectively evaluated. Skeletal muscle index (SMI) and muscle density [mean Hounsfield unit (HU)] were measured at the L3 vertebral level on pretreatment CT. Clinicopathological variables, including molecular subtype, histological grade, and clinical stage, were recorded. Treatment response was categorized as pCR or non-pCR. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of pCR. Receiver operating characteristic (ROC) analysis was used to assess the predictive performance of SMI and HU.
Results:
A total of 365 patients (mean age, 50.2±11.79 years) were included, and pCR was achieved in 27.9% of cases. Molecular subtype was the strongest independent predictor of treatment response, with the highest pCR rates observed in HER2-positive tumors and the lowest in luminal tumors. Histological grade was associated with pCR in univariate analysis but lost significance in multivariate analysis. Neither SMI nor HU independently predicted pCR. Additional analyses according to molecular subtype demonstrated no significant associations between SMI, HU, and treatment response in luminal, HER2-positive, or triple-negative breast cancer subgroups. ROC analyses showed poor discriminatory performance of both parameters in the overall cohort and subtype-specific analyses (area under the curve range, 0.477-0.565).
Conclusion:
Molecular subtype remains the primary predictor of treatment response following NAC. In contrast, CT-derived SMI and muscle density showed no predictive value for pCR in either the overall cohort or molecular subtype-specific analyses, suggesting that tumor biology plays a more dominant role than body composition in determining treatment response.
