Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Atlanta, GA, USA.
Ann Surg Oncol. 2021 Oct;28(11):6140-6151. doi: 10.1245/s10434-021-09773-7. Epub 2021 Mar 14.
The impact of obesity on early-stage melanoma is poorly understood. We examined the impact of overweight and obesity on clinical outcomes in locoregional melanoma.
Adults who underwent surgery at Emory University Healthcare between 2010 and 2017 for clinically stage I-II cutaneous melanoma, with known stage, height, and weight at the time of presentation, were identified. The relationship between body mass index (BMI) and clinicopathologic characteristics was assessed.
Of 1756 patients, 584 were obese (33.2%; BMI ≥ 30), 658 were overweight (37.5%; BMI ≥ 25 and < 30), and 514 were normal weight (29.3%; BMI < 25). Demographics associated with obesity included male sex (odds ratio [OR] 2.6, 95% confidence interval [CI] 2.1-3.3; p < 0.001) and lower income (OR 1.5, 95% CI 1.2-1.9; p = 0.003). Melanomas in obese patients were thicker (2.0 ± 0.2 mm) than in overweight (1.7 ± 0.1 mm) or normal-weight patients (1.4 ± 0.1 mm; p = 0.002). Ulceration, mitoses, BRAF status, and sentinel lymph node (SLN) status were not affected by obesity. In multivariable analysis, obesity independently predicted increased odds of pathologic stage II melanoma (vs. stage 0 or I; OR 1.9, 95% CI 1.4-2.7, p = 0.001), but not pathologic stage III melanoma (p > 0.05). At 33 months' median follow-up, obesity was not an independent predictor of stage-specific overall survival (p > 0.05).
Obese patients are nearly twice as likely as their normal-weight peers to present with thicker melanomas, but they have similar stage-specific overall survival and SLN positivity. Obesity may promote more aggressive growth of the primary tumor, and barriers to preventive care in obese patients may exacerbate later-stage presentation.
肥胖对早期黑色素瘤的影响尚未被充分认识。我们研究了超重和肥胖对局部区域黑色素瘤临床结局的影响。
我们在 2010 年至 2017 年期间，在埃默里大学医疗保健中心接受手术治疗的临床 I 期- II 期皮肤黑色素瘤患者，已知分期、就诊时的身高和体重，患者被确定。评估体重指数（BMI）与临床病理特征之间的关系。
在 1756 名患者中，584 名患者肥胖（33.2%；BMI≥30），658 名患者超重（37.5%；BMI≥25 且<30），514 名患者体重正常（29.3%；BMI<25）。与肥胖相关的人口统计学特征包括男性（比值比 [OR] 2.6，95%置信区间 [CI] 2.1-3.3；p<0.001）和低收入（OR 1.5，95% CI 1.2-1.9；p=0.003）。肥胖患者的黑色素瘤厚度（2.0±0.2mm）大于超重（1.7±0.1mm）或体重正常患者（1.4±0.1mm；p=0.002）。溃疡、有丝分裂、BRAF 状态和前哨淋巴结（SLN）状态不受肥胖影响。多变量分析显示，肥胖独立预测病理性 II 期黑色素瘤（与 0 期或 I 期相比；OR 1.9，95% CI 1.4-2.7，p=0.001）的可能性增加，但不预测病理性 III 期黑色素瘤（p>0.05）。在 33 个月的中位随访中，肥胖不是特定阶段总生存率的独立预测因素（p>0.05）。
肥胖患者与体重正常的同龄人相比，黑色素瘤更厚的可能性几乎增加了一倍，但他们具有相似的特定阶段总生存率和 SLN 阳性率。肥胖可能促进原发性肿瘤更具侵袭性的生长，而肥胖患者预防保健方面的障碍可能会加剧晚期发病。
