Obesity is not associated with disease‐free interval, melanoma‐specific survival, or overall survival in patients with clinical stage IB‐II melanoma after SLNB

Abstract

Background and Objectives Clinicopathologic characteristics have prognostic value in clinical stage IB‐II patients with melanoma. Little is known about the prognostic value of obesity that has been associated with an increased risk for several cancer types and worsened prognosis after diagnosis. This study aims to examine effects of obesity on outcome in patients with clinical stage IB‐II melanoma. Methods Prospectively recorded data of patients with clinical stage IB‐II melanoma who underwent sentinel lymph node biopsy (SLNB) between 1995 and 2018 at the University Medical Center of Groningen were collected from medical files and retrospectively analyzed. Cox‐regression analyses were used to determine associations between obesity (body mass index> 30), tumor (location, histology, Breslow‐thickness, ulceration, mitotic rate, SLN‐status) and patient‐related variables (gender, age, and social‐economic‐status [SES]) and disease‐free interval (DFI), melanoma‐specific survival (MSS), and overall survival (OS). Results Of the 715 patients, 355 (49.7%) were women, median age was 55 (range 18.6‐89) years, 149 (20.8%) were obese. Obesity did not significantly affect DFI (adjusted hazard ratio [HR] = 1.40; 95% confidence interval [CI] = 0.98–2.00; p = 0.06), MSS (adjusted HR = 1.48;95%CI = 0.97–2.25; p = 0.07), and OS (adjusted HR = 1.25; 95% CI = 0.85–1.85; p = 0.25). Increased age, arm location, increased Breslow‐thickness, ulceration, increased mitotic rate, and positive SLN‐status were significantly associated with decreased DFI, MSS, and OS. Histology, sex, and SES were not associated. Conclusion Obesity was not associated with DFI, MSS, or OS in patients with clinical stage IB‐II melanoma who underwent SLNB.

Body mass index, weight change, and cancer prognosis: a meta-analysis and systematic review of 73 cohort studies

“…Papers with HR data for OS were retained for BMI-related data ( n = 52). 24 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 For weight change-related data, both HR data for OS and mortality data with events and total number of people in the exposed and non-exposed groups as initial data were retained ( n = 27). 24 , 26 , 41 , 48 , 51 , 76 , 86 , 87 , 88 , 89 , 90 , 91 , 92...…”

“…The results of the obese versus nonobese analysis are shown in Figure 2 . In this analysis, we included 22 studies, 24 , 37 , 42 , 43 , 44 , 46 , 47 , 50 , 53 , 55 , 56 , 59 , 66 , 67 , 71 , 72 , 74 , 77 , 80 , 81 , 84 with a total I 2 of 83% and an HR of 0.96 (95% CI 0.81-1.13; P = 0.59). Eight studies were included in the analysis of reproductive system cancers, including breast cancer ( n = 7) and endometrial cancer ( n = 1), and the results were not statistically significant.…”

“…We finally selected three papers each that specifically examined early-staged 37 , 42 , 66 or advanced-staged 43 , 44 , 73 tumors. We carried out a meta-analysis of the relationship between obesity and tumor OS for early-stage overall cancers and advanced-stage overall cancers independently.…”

The Effect of Body Mass Index on Melanoma Biology, Immunotherapy Efficacy, and Clinical Outcomes: A Narrative Review

“…Similarly, Kondo et al (2018) and Cortellini et al (2019) emphasized BMI’s prognostic importance in melanoma and other malignancies treated with ICIs [ 41 , 42 ]. Conversely, Rutkowski et al (2020), Deckers et al (2021), and Zepeda-Najar et al (2021) presented varied outcomes regarding obesity’s prognostic significance in melanoma [ 6 , 26 , 43 ]. Di Filippo et al (2021), Lee et al (2022), and Antoun et al (2023) nuanced this discussion by suggesting that BMI alone may not fully capture the impact of a patient’s body composition on prognosis, highlighting the importance of considering other factors such as skeletal muscle mass [ 44 , 45 , 46 ].…”

“…Nevertheless, the dynamics between BMI, treatment efficacy, and prognosis are complex. Variations in how BMI affects treatment outcomes indicate that the survival benefits associated with higher BMI might differ based on gender, type of treatment, and other variables [ 6 , 26 , 43 , 44 , 45 , 46 , 47 , 51 , 52 ]. Moreover, the counterintuitive nature of these results, where factors typically linked to negative health outcomes emerge as indicators of better survival and response to treatment, calls for a reassessment of BMI’s role in cancer metabolism and immunotherapy responses [ 11 ].…”