Predicting 10-year survival in early and locally advanced breast cancer: prognostic value of nutritional status and body composition.

[AIM] This study aimed to evaluate the prognostic impact of nutritional status assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) and body composition parameters on 10-year overall survival (OS) in patients with early and locally advanced breast cancer.

[METHODS] This retrospective longitudinal study included 437 women aged over 18 years diagnosed with stage I-III breast cancer between 2015-2017. Patients with metastatic disease at diagnosis or incomplete data were excluded. Nutritional status was assessed using PG-SGA. Body composition was measured via bioelectrical impedance analysis. Clinical data and antropometric measuremets were collected from electronic medical records. ROC analysis identified cut-off values, and Kaplan-Meier and Cox regression analyses evaluated the impact of nutrition and body composition on OS.

[RESULTS] The median follow-up was 117.7 months (mean 121.2 ± 51.1 months). PG-SGA cut-off value of 5.5 effectively stratified patients into low- and high-risk nutritional groups. Higher PG-SGA scores were significantly associated with poorer OS (HR = 1.057; 95% CI: 1.021-1.094; p = .002). Anthropometric measurements including calf circumference, mid-arm circumference, skinfold thickness, body mass index (BMI), fat-free mass, and muscle mass predicted survival outcomes (all p < .05). Patients with PG-SGA ≥5.5 had a median survival of 145.8 months (95% CI: 130.3-161.4), compared to 285.7 months (95% CI: 267.9-303.5) in those with lower scores (p < .001). Similarly, higher body composition metrics correlated with significantly longer survival. Multivariate analysis confirmed PG-SGA and body composition parameters as independent prognostic factors, adjusting for age, stage, disease progression (defined as the development of distant metastases during follow-up), and receipt of systemic treatment during follow-up.

[CONCLUSION] Nutritional status and body composition are valuable predictors of long-term survival in early and locally advanced breast cancer. Defining a PG-SGA threshold in this setting, our study highlights the importance of integrating nutritional assessment into routine care, even beyond advanced disease.