Computed tomography assessment of body composition in patients with nonmetastatic breast cancer: what are the best prognostic markers?

Objective: To correlate body composition measures, based on computed tomography (CT) analysis of muscle mass and adipose tissue, with disease-free survival in breast cancer patients. Materials and Methods: This single-center retrospective study included 262 female patients with nonmetastatic breast cancer. Body composition was assessed on a pretreatment CT scan (at the L3 level). The analysis included quantification of the areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle mass, as well as of the mean skeletal muscle density. The VAT/SAT ratio, skeletal mass index (SMI), and skeletal muscle gauge (SMG) were calculated. Results: Of the 262 patients evaluated, 175 (66.8%) were classified as overweight or obese on the basis of their body mass index. We observed low SMI in 35 patients (13.4%) and elevated VAT in 123 (46.9%). Disease-free survival was significantly shorter in the patients who underwent neoadjuvant chemotherapy (p = 0.044), in those with a low SMI (p = 0.006), in those with low SMG (p = 0.013), and in those with a low VAT/SAT ratio (p = 0.050). In a multivariate analysis, only SMG, the VAT/SAT ratio, and having undergone neoadjuvant chemotherapy retained their statistical significance. Conclusion: Our results confirm that low SMG and the VAT/SAT ratio can be used as imaging biomarkers to assess prognosis in patients with nonmetastatic breast cancer.

Objetivo: Correlacionar medidas de composição corporal baseadas na análise por tomografia computadorizada (TC) da massa muscular e tecido adiposo com a sobrevida livre de doença em pacientes com câncer de mama. Materiais e Métodos: Estudo retrospectivo unicêntrico que incluiu 262 mulheres com câncer de mama não metastático. Avaliação da composição corporal foi realizada na TC pré-tratamento (nível de L3), incluindo tecido adiposo subcutâneo (SAT) e tecido adiposo visceral (VAT), massa muscular esquelética e densidade do músculo esquelético. A relação VAT/SAT, o índice de massa esquelética (SMI) e o produto do músculo esquelético (SMG) foram calculados. Resultados: De acordo com o índice de massa corporal, 175 (66,8%) pacientes foram classificadas com sobrepeso ou obesidade. Baixo SMI foi observado em 35 (13,4%) pacientes e VAT elevado, em 123 (46,9%). Houve uma redução significativa na sobrevida livre de doença nas pacientes que realizaram quimioterapia neoadjuvante (p = 0,044), nas com baixo SMI (p = 0,006), baixo SMG (p = 0,013) e baixa relação VAT/SAT (p = 0,050). Na análise multivariada, apenas SMG, relação VAT/SAT e quimioterapia neoadjuvante confirmaram significância estatística. Conclusão: Nossos resultados confirmaram que SMG e relação VAT/SAT baixos podem ser usados como importantes biomarcadores de imagem para avaliar o prognóstico em pacientes com câncer de mama não metastático.

Computed tomography assessment of body composition in patients with nonmetastatic breast cancer: what are the best prognostic markers? / Avaliação da composição corporal por tomografia computadorizada em pacientes com câncer de mama não metastático: quais os melhores marcadores de prognóstico?

Abstract Objective: To correlate body composition measures, based on computed tomography (CT) analysis of muscle mass and adipose tissue, with disease-free survival in breast cancer patients. Materials and Methods: This single-center retrospective study included 262 female patients with nonmetastatic breast cancer. Body composition was assessed on a pretreatment CT scan (at the L3 level). The analysis included quantification of the areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle mass, as well as of the mean skeletal muscle density. The VAT/SAT ratio, skeletal mass index (SMI), and skeletal muscle gauge (SMG) were calculated. Results: Of the 262 patients evaluated, 175 (66.8%) were classified as overweight or obese on the basis of their body mass index. We observed low SMI in 35 patients (13.4%) and elevated VAT in 123 (46.9%). Disease-free survival was significantly shorter in the patients who underwent neoadjuvant chemotherapy (p = 0.044), in those with a low SMI (p = 0.006), in those with low SMG (p = 0.013), and in those with a low VAT/SAT ratio (p = 0.050). In a multivariate analysis, only SMG, the VAT/SAT ratio, and having undergone neoadjuvant chemotherapy retained their statistical significance. Conclusion: Our results confirm that low SMG and the VAT/SAT ratio can be used as imaging biomarkers to assess prognosis in patients with nonmetastatic breast cancer.

Resumo Objetivo: Correlacionar medidas de composição corporal baseadas na análise por tomografia computadorizada (TC) da massa muscular e tecido adiposo com a sobrevida livre de doença em pacientes com câncer de mama. Materiais e Métodos: Estudo retrospectivo unicêntrico que incluiu 262 mulheres com câncer de mama não metastático. Avaliação da composição corporal foi realizada na TC pré-tratamento (nível de L3), incluindo tecido adiposo subcutâneo (SAT) e tecido adiposo visceral (VAT), massa muscular esquelética e densidade do músculo esquelético. A relação VAT/SAT, o índice de massa esquelética (SMI) e o produto do músculo esquelético (SMG) foram calculados. Resultados: De acordo com o índice de massa corporal, 175 (66,8%) pacientes foram classificadas com sobrepeso ou obesidade. Baixo SMI foi observado em 35 (13,4%) pacientes e VAT elevado, em 123 (46,9%). Houve uma redução significativa na sobrevida livre de doença nas pacientes que realizaram quimioterapia neoadjuvante (p = 0,044), nas com baixo SMI (p = 0,006), baixo SMG (p = 0,013) e baixa relação VAT/SAT (p = 0,050). Na análise multivariada, apenas SMG, relação VAT/SAT e quimioterapia neoadjuvante confirmaram significância estatística. Conclusão: Nossos resultados confirmaram que SMG e relação VAT/SAT baixos podem ser usados como importantes biomarcadores de imagem para avaliar o prognóstico em pacientes com câncer de mama não metastático.

Hormesis in plants: Physiological and biochemical responses.

Hormesis is a favorable response to low level exposures to substance or to adverse conditions. This phenomenon has become a target to achieve greater crop productivity. This review aimed to address the physiological mechanisms for the induction of hormesis in plants. Some herbicides present a hormetic dose response. Among them, those with active ingredients glyphosate, 2,4-D and paraquat. The application of glyphosate as a hormesis promoter is therefore showing promess . Glyphosate has prominent role in shikimic acid pathway, decreasing lignin synthesis resulting in improved growth and productivity of several crops. Further studies are still needed to estimate optimal doses for other herbicides of crops or agricultural interest. Biostimulants are also important, since they promote effects on secondary metabolic pathways and production of reactive oxygen species (ROS). When ROS are produced, hydrogen peroxide act as a signaling molecule that promote cell walls malleability allowing inward water transport causing cell expansion. . Plants'ability to overcome several abiotic stress conditions is desirable to avoid losses in crop productivity and economic losses. This review compiles information on how hormesis in plants can be used to achieve new production levels.

Use of cystatin C and serum creatinine for the diagnosis of contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography at an oncology centre.

OBJECTIVE: Our aim was to assess renal function using as laboratory measurements serum creatinine and cystatin C concentrations before and after administration of low-osmolarity (nonionic) iodinated contrast medium in patients with cancer undergoing computed tomography (CT). METHODS: This prospective study included 400 oncologic outpatients. Serum creatinine and cystatin C concentrations were measured before and 72 h after contrast administration. Glomerular filtration rates (GFRs) were estimated using serum creatinine-based [Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault and cystatin C based (Larsson) equations. Exploratory data analysis was performed. The nonparametric Wilcoxon test was used to compare pre and post contrast of test results and estimated clearance. The confidence interval used in the analysis was 95%. RESULTS: Compared with the pre-contrast values, the mean serum creatinine concentration was significantly higher and average GFRs estimated using MDRD and Cockcroft-Gault equations were significantly lower after the administration of contrast (p <0.001). It was also observed a significant increase after contrast in the concentration of Cystatin C (p = 0.015). In addition, a decrease in GFR estimated using the average Larsson (p = 0.021) was observed between time points. However, none of the patients presented clinically significant nephropathy. CONCLUSIONS: Assessment using serum creatinine and cystatin C concentrations showed changes in renal function among patients with cancer undergoing contrast-enhanced CT examination in this study. No significant renal damage related to the use of low-osmolarity iodinated contrast medium of the type and dosage employed in this study was observed. This contrast medium is thus safe for use in patients with cancer.