Sarcopenia as a Prognostic Factor among Patients with Stage III Melanoma
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Several hypotheses proposed to explain the worse prognosis for older melanoma patients include different tumor biology and diminished host response. If the latter were true, then biologic frailty, and not age, should be an independent prognostic factor in melanoma.
Our prospective institutional review board (IRB)-approved database was queried for stage III patients with computed tomography (CT) scans at time of lymph node dissection (LND). Psoas area (PA) and density (PD) were determined in semi-automated fashion. Kaplan–Meier (K–M) survival estimates and Cox proportional-hazard models were used to determine PA and PD impact on survival and surgical complications.
Among 101 stage III patients, PD was significantly associated with both disease-free survival (DFS) (P = 0.04) and distant disease-free survival (DDFS) (P = 0.0002). Cox multivariate modeling incorporating thickness, age, ulceration, and N stage showed highly significant association with PD and both DFS and DDFS. DDFS was significantly associated with Breslow thickness (P = 0.04), number of positive nodes (P = 0.001), ulceration (P = 0.04), and decreasing muscle density (P = 0.01), with hazard ratio of 0.55 [95% confidence interval (CI) 0.35–0.87]. PD also correlated with surgical complications, with odds ratio (OR) of 1.081 [95% CI 1.016–1.150, P = 0.01].
Decreased psoas muscle density on CT, an objective measure of frailty, was as important a predictor of outcome as tumor factors in a cohort of stage III melanoma patients. On multivariate analysis, frailty, not age, was associated with decreased disease-free survival and distant disease-free survival, and higher rate of surgical complications.
Supplementary Material (0)
- Balch CM, Soong S-J, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19(16):3622–34.
- Austin RF, Cruse CW, Lyman GH, et al. Age as a prognostic factor in the malignant melanoma population. Ann Surg Oncol. 1994;1(6):487–94. CrossRef
- Lasithiotakis K, Leiter U, Meier F, et al. Age and gender are significant independent predictors of survival in primary cutanous melanoma. Cancer. 2008;112:1795–804. CrossRef
- Paek SC, Griffith KA, Johnson TM, et al. The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma. Cancer. 2007;109(1):100-8. CrossRef
- Statius Muller MG, van Leeuwen PAM, de Lange-De Klerk ES, et al. The sentinel lymph node status is an important factor for predicting clinical outcome in patients with stage I or II cutaneous melanoma. Cancer. 2001;91(12):2401–8. CrossRef
- Tsai S, Balch CM, Lange J. Epidemiology and treatment of melanoma in elderly patients. Nat Rev Clin Oncol. 2010;7:148–152. CrossRef
- Englesbe MJ, Patel SP, He K, et al. Sarcopenia and mortality after liver transplantation. JACS. 2010;211(2):271–278.
- Lang PO, Michel JP, Zekry D. Frailty syndrome: a transitional state in a dynamic process. Gerontology. 2009;55(5):539–49. CrossRef
- Marcell TJ. Sarcopenia: causes, consequences and preventions. J Gerontol A Biol Sci Med Sci. 2003;58(10):M911–6. CrossRef
- Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. CrossRef
- Buchman AS, Wilson RS, Bienias JL, et al. Change in frailty and risk of death in older persons. Exp Aging Res. 2009;35(1):61–82. CrossRef
- Longstreth WT, Bernick C, Fitzpatrick A, et al. Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study. Neurology. 2001;56(3):368–75.
- Baumgartner RN, Wayne SJ, Waters DL, et al. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res. 2004;12(12):1995–2004. CrossRef
- Villareal DT, Banks M, Sinacore DR, et al. Effect of weight loss and exercise on frailty in obese, older adults. Arch Intern Med. 2006;166(8):860–866. CrossRef
- Goodpaster BH, Thaete FL, Kelley DE. Skeletal muscle composition evaluated with computed tomography. Ann NY Acad Sci. 2000;904:18–24. CrossRef
- Goodpaster BH, Kelley DE, Thaete FL, et al. Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol. 2000;89:104–110.
- Hsu M-Y, Meier F, Herlyn M. Melanoma development and progression: a conspiracy between tumor and host. Differentiation. 2002;70:522-536. CrossRef
- van den Biggelaar AHJ, Huizinga TWJ, de Craen AJM, et al. Impaired innate immunity predicts frailty in old age: the Leiden 85-plus study. Exp Gerontol. 2004;39:1407–1414. CrossRef
- Paganelli R, Di Iorio A, Cherubini A, et al. Frailty of older age: the role of the endocrine-immune interaction. Curr Pharm Des. 2006;12:3147–3159. CrossRef
- Yao X, Li H, Leng SX. Inflammation and immune system alterations in frailty. Clin Geriatr Med. 2011;27:79–87. CrossRef
- Schafer AL, Vittinghoff E, Lang TF, et al. Fat infiltration of muscle, diabetes and clinical fracture risk in older adults. J Clin Endocrin Metab. 2010;95.
- Zoico E, Rossi A, De Francesco V, et al. Adipose tissue infiltration in skeletal muscle of healthy, elderly men: relationships with body composition, insulin resistance and inflammation at the systemic and tissue level. J Gerontol a Biol Sci Med Sci. 2010;65A(3):295–299. CrossRef
- Gilsanz V, Kremer A, Mo AO, et al. Vitamin D status and its relation to muscle mass and muscle fat in young women. J Clin Endocrin Metab. 2010;95:1595–1601. CrossRef
- Walston J, McBurnie MA, Newman A, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical morbidities: results from the Cardiovascular Health Study. Arch Intern Med. 2002;162:2333–2341. CrossRef
- Leng S, Chaves P, Koenig KL, et al. Serum IL-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study. J Am Geriatr Soc. 2002;50:1268–1271. CrossRef
- Tartour E, Dorval T, Mosseri V, et al. Serum interleukin-6 and C-reactive protein levels correlate with resistance to IL-2 therapy and poor survival in melanoma patients. Br J Cancer. 1994;69(5):911–913. CrossRef
- Holick MF. Vitamin D deficiency. New Engl J Med. 2007;357:266–281. CrossRef
- Berwick M, Armstrong BK, Ben-Porat L, et al. Sun exposure and mortality from melanoma. J Natl Cancer Inst. 2005;97:195–9. CrossRef
- Fang JS, Gillies RD, Gatenby RA. Adaptation to hypoxia and acidosis in carcinogenesis and tumor progression. Semin Cancer Biol. 2008;18(5):330–7. CrossRef
- Kapur P, Rakheja D, Roy LC, et al. Fatty acid synthase expression in cutaneous melanocytic neoplasms. Mod Pathol. 2005;18:1107–12. CrossRef
- Innocenzi D, Alo PL, Alzani A, et al. Fatty acid synthase expression in melanoma. J Cutan Pathol. 2003;30:23–8. CrossRef
About this Article
- Sarcopenia as a Prognostic Factor among Patients with Stage III Melanoma
Annals of Surgical Oncology
Volume 18, Issue 13 , pp 3579-3585
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Author Affiliations
- 1. Departments of Surgery, University of Michigan, Ann Arbor, MI, USA
- 2. Departments of Biostatistics, University of Michigan, Ann Arbor, MI, USA