Underlying Health of Melanoma Patients Can Determine Survival Outcome

 

Melanoma will be diagnosed in 68,130 Americans this year with 8700 dying of the disease, according to the American Cancer Society. Contrary to popular belief, however, it’s not how old patients are but rather the frailty of their health that can predict how well they will fare after a melanoma diagnosis. In fact, older melanoma patients with good health may have better outcomes than younger patients in poor health.

Patients with decreased core muscle density were more likely to experience the spread of their cancer to other parts of the body, according to a new study from the University of Michigan Comprehensive Cancer Center.

The idea that the patient’s biological response to a tumor is significant in managing the spread of melanoma may also be supported by these study findings. In other words, patients who are less able to deliver a response due to frail health may be more prone to their cancer metastasizing.

The study, which appears online in Annals of Surgical Oncology, looked at 101 patients treated for stage III melanoma at the University of Michigan Comprehensive Cancer Center. CT scans for each patient were examined to measure the area and density of a core muscle that runs along both sides of the spine.

According to researchers, melanoma patients with lower muscle density had significantly higher rates of their cancer returning, regardless of the tumor size or the patient’s age. For every 10 units of decreased muscle density there was a 28% increase in cancer recurrence. In addition, patients in frail health experienced more surgical complications with the removal of their cancerous lymph nodes.

The researchers believe that treatment decisions, including the use of new immunotherapy drugs, could be impacted by identifying those patients who show a higher risk of poor outcomes. And potentially, patients might have better outcomes, if their sarcopenia can be reversed.

“The big question is if we could reverse sarcopenia through better nutrition and exercise, would that lead to a decreased risk of recurrence in those patients?” says lead study author Michael Sabel, MD, associate professor of surgery at the U-M Medical School.

Researchers also feel the limited success of new immunotherapy or cancer vaccine treatments may be related to the study findings.

“The data suggests that frailer patients may be less likely to respond to these forms of therapy. It is very possible that prior trials of vaccines or other immune therapies that didn’t show an effect would have shown an effect if we had weeded out the patients unlikely to respond to therapy,” Sabel says.

 

Reference: Sabel MS, Lee J, Cai S, et al. Sarcopenia as a prognostic factor among patients with stage III melanoma [published online ahead of print August 6, 2011]. Ann Surg Oncol.

Source: University of Michigan Comprehensive Cancer Center