J Breast Cancer.  2020 Feb;23(1):80-92. 10.4048/jbc.2020.23.e8.

Prognostic Value of Skeletal Muscle Depletion Measured on Computed Tomography for Overall Survival in Patients with Non-Metastatic Breast Cancer

  • 1Department of Radiology, Ajou University School of Medicine, Suwon, Korea. h219435@gmail.com
  • 2Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
  • 3Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea.
  • 4Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
  • 5Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Suwon, Korea.


The purpose of this study was to evaluate the prognostic value of skeletal muscle depletion measured on computed tomography (CT) in patients with non-metastatic invasive breast cancer.
This retrospective study included 577 consecutive women (mean age ± standard deviation: 48.9 ± 10.2 years with breast cancer who underwent a preoperative positron-emission tomography (PET)/CT scan and curative surgery between January 2012 and August 2014. The total abdominal muscle area (TAMA), subcutaneous fat area (SFA), and visceral fat area (VFA) were measured on CT images at the L3 vertebral level. Univariate and multivariate Cox proportional-hazard regression analyses were performed to evaluate whether there was an association between sarcopenia and overall survival (OS) outcome.
Of the 577 women, 49 (8.5%) died after a mean of 46 months. The best TAMA threshold for predicting OS was 83.7 cm². The multivariate Cox proportional-hazard analysis revealed that sarcopenia (TAMA ≤ 83.70 cm²) was a strong prognostic biomarker (hazard ratio [HR], 1.951; 95% confidence interval [CI], 1.061-3.586), along with large tumor size, axillary lymph node metastasis, high nuclear grade, estrogen receptor status, and adjuvant radiation therapy. In the subgroup analysis of patients aged ≥ 50 years, TAMA (≤ 77.14 cm²) was a significant independent factor (HR, 2.856; 95% CI, 1.218-6.695).
Skeletal muscle depletion measured on CT was associated with worse OS outcome in patients with non-metastatic breast cancer.


Breast; Carcinoma; Sarcopenia; Survival

MeSH Terms

Abdominal Muscles
Breast Neoplasms*
Intra-Abdominal Fat
Lymph Nodes
Muscle, Skeletal*
Neoplasm Metastasis
Positron-Emission Tomography
Retrospective Studies
Subcutaneous Fat


  • Figure 1 Flowchart of study population. 18F-FDG = 18F-labeled fluoro-2-deoxyglucose; PET = positron-emission tomography; CT = computed tomography.

  • Figure 2 Body morphometric evaluation of abdominal fat and muscle areas. At the level of the inferior endplate of the L3 vertebra, the axial CT image is segmented into the total abdominal muscle area (purple), superficial fat area (brown), and visceral fat area (green). CT = computed tomography.

  • Figure 3 Boxplot graphs show a statistically significant difference in the TAMA among all age groups except between <40 and 40–49 years age groups. TAMA = total abdominal muscle area.

  • Figure 4 Kaplan-Meier curves show the OS according to TAMA in all 577 patients (A) and in patients older than 50 years of age (B). OS = overall survival; TAMA = total abdominal muscle area.


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