Frailty undermines outcomes in melanoma

Patient frailty appears to be just as important a predictor of outcome as tumor factors in persons with stage III melanoma, according to a recent study that found frailty—not age—to be associated with decreased disease-free survival and distant disease-free survival, as well as with a higher rate of surgical complications. 

Although previous research has linked older age to worse outcomes in melanoma, it now appears that the patient's underlying vitality is what really matters. Michael S. Sabel, MD, associate professor of surgery at the University of Michigan Medical School in Ann Arbor, and colleagues used CT scans to measure area and density of the psoas muscle, which extends along both sides of the spinal column, in 101 patients with stage III melanoma. As they reported in Annals of Surgical Oncology, psoas density—indicating core muscle strength—was significantly associated with both disease-free survival and distant disease-free survival.

Conversely, patients with lower muscle density had significantly higher rates of cancer recurrence, regardless of such factors as tumor size or patient age: Every 10 units of decreased muscle density translated to a 28% increase in recurrence. In addition, frailer patients had more complications from surgical removal of cancerous lymph nodes.

Potentially, reversal of this degenerative muscle loss (sarcopenia) through nutrition and exercise may lead to better outcomes for patients. These new findings may also eventually help explain why vaccines or other immunotherapies did not show effectiveness in prior trials. “[Those treatments might] have shown an effect if we had weeded out the patients unlikely to respond to therapy,” remarked Sabel in a statement describing his team's study.

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