The Impact of Obesity on Surgically Treated Locoregional Melanoma

Hyung

et al. 2022

J Immunother Cancer

BackgroundThe obesity paradox is a topic of increasing interest in oncology and epidemiology research. Although this phenomenon has been observed in melanoma patients receiving immune checkpoint inhibitors, little is known about its mechanism. We aim to investigate the prognostic value of obesity and its association with adiposity and systemic inflammation.MethodsThis retrospective study evaluates the data of patients who received pembrolizumab or nivolumab for unresectable or metastatic melanoma between June 2015 and April 2021. The skeletal muscle index (SMI) and visceral fat index (VFI) (cm2/m2) were calculated by dividing the cross-sectional areas of skeletal muscle and visceral fat by height squared. The systemic immune-inflammation index (SII) was defined as the total peripheral platelet count×neutrophil/lymphocyte ratio. Cox proportional hazard regression analysis was conducted to determine the association with overall survival.ResultsWe analyzed 266 patients with a median age of 60 years (IQR 51–69 years; 135 men and 131 women). The protective effect of obesity was independent of covariates (HR 0.60; 95% CI 0.37 to 0.99; p=0.048), but disappeared after adjusting for VFI (HR 0.76; 95% CI 0.41 to 1.40; p=0.380) or SII (HR 0.71; 95% CI 0.42 to 1.18; p=0.186). An increase of 10 cm2/m2 in VFI was associated with longer overall survival after adjusting for covariates (HR 0.88; 95% CI 0.79 to 0.99; p=0.029). The prognostic value of VFI remained and predicted favorable overall survival after additional adjustment for SMI (HR 0.86; 95% CI 0.76 to 0.98; p=0.025), but disappeared with adjustment for SII (HR 0.92; 95% CI 0.82 to 1.03; p=0.142). An increase of 100×109/L in SII was associated with poor overall survival when adjusted for covariates (HR 1.08; 95% CI 1.05 to 1.11; p<0.001) or when additionally adjusted for VFI (HR 1.07; 95% CI 1.04 to 1.10; p<0.001).ConclusionsVisceral adiposity and systemic inflammation are significant prognostic factors in patients with unresectable or metastatic melanoma receiving immune checkpoint inhibitors. The prognostic impact of visceral adiposity is dependent on systemic inflammation status.

Section: Discussionmentioning

confidence: 99%

“…Obesity is associated with an increased risk of melanoma among males, 27 thicker tumor at presentation, 28 and worse postoperative survival. 29 However, McQuade et al 7 reported that this association seems to be reversed when systemic therapy is administered, resulting in improved OS in patients with obesity.…”

Section: Discussionmentioning

confidence: 99%

Visceral adiposity and systemic inflammation in the obesity paradox in patients with unresectable or metastatic melanoma undergoing immune checkpoint inhibitor therapy: a retrospective cohort study

Hyung

et al. 2022

J Immunother Cancer

“…There is little research on the role of obesity in the development of melanoma metastases. To our knowledge, only Shreckengost et al analyzed the impact of obesity on sentinel lymph node metastases [ 18 ]. Contrary to their results, our study showed a significant influence of BMI >= 35 on sentinel lymph node metastases, one of the main predictors of melanoma prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Metastases in sentinel lymph nodes and their relationship with obesity has only been mentioned by Shreckengost et al as not existent [ 18 ]. To our knowledge, no previous studies have addressed this possible causality.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Obesity on Melanoma and Sentinel Lymph Node Diagnosis: A Retrospective Monocentric Study in 1001 Patients

Oliveira

Klose

Schulze

et al. 2023

Cancers

(1) Background: While obesity is a known independent risk factor in the development of melanoma, there is no consensus on its influence on melanoma prognosis. (2) Methods: In a monocentric retrospective study, data was collected from patients who underwent sentinel lymph node (SLN) biopsy for stage IB-IIC melanoma between 2013 and 2018. Patients were divided into groups according to their body mass index (BMI). The association between BMI and melanoma features, as well as the risk factors for metastases in SLN were examined. (3) Results: Of the 1001 patients, 336 had normal weight (BMI < 25), 402 were overweight (BMI >= 25 and <30), 173 obese (BMI >= 30 and <35) and 90 extremely obese (BMI >= 35). Overweightness and obesity were associated with higher tumor thicknesses at time of diagnosis. Ulceration was not influenced by the patient’s weight. Metastases in sentinel lymph node was almost twice more likely in extremely obese patients than in normal weight patients. Independent risk factors for metastases in SLN in our study were tumor thickness, ulceration, and BMI > 35. (4) Conclusions: This is the first study to show higher metastases rates in high-BMI patients with melanoma, raising important questions regarding the screening and treatment of this specific patient population.

“…Obesity was associated with increased wound dehiscence, incisional site hernia, and stoma complications following colorectal surgery, and these patients were at higher risk for conversion to an open surgery [80]. Obese patients were found to present with melanomas that were twice as thick as their non-obese peers [81]. Following surgical resection of squamous cell carcinoma (SCC) of the tongue, obese patients had worse disease-specific survival (DSS), recurrence-free survival (RFS), and overall survival (OS) [82].…”

Section: Obesity and Cancer Prognosismentioning

confidence: 99%

Exploring the Impact of the Obesity Paradox on Lung Cancer and Other Malignancies

Nitsche

Mukherjee

Cheruvu

et al. 2022

Cancers

There is a paradoxical relationship between obesity, as measured by BMI, and many types of cancer, including non-small-cell lung cancer. Obese non-small-cell lung cancer patients have been shown to fare better than their non-obese counterparts. To analyze the multifaceted effects of obesity on oncologic outcomes, we reviewed the literature on the obesity paradox, methods to measure adiposity, the obesity-related derangements in immunology and metabolism, and the oncologic impact of confounding variables such as gender, smoking, and concomitant medications such as statins and metformin. We analyzed how these aspects may contribute to the obesity paradox and cancer outcomes with a focus on lung cancer. We concluded that the use of BMI to measure adiposity is limited and should be replaced by a method that can differentiate abdominal obesity. We also concluded that the concomitant metabolic and immunologic derangements caused by obesity contribute to the obesity paradox. Medications, gender, and smoking are additional variables that impact oncologic outcomes, and further research needs to be performed to solidify the mechanisms.