caa a22 4500 445338903 CHVBK 20180317142805.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1245/s10434-011-1976-9 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1976-9 Sarcopenia as a Prognostic Factor among Patients with Stage III Melanoma [Elektronische Daten] [Michael Sabel, Jay Lee, Shijie Cai, Michael Englesbe, Stephen Holcombe, Stewart Wang] Background: Several hypotheses proposed to explain the worse prognosis for older melanoma patients include different tumor biology and diminished host response. If the latter were true, then biologic frailty, and not age, should be an independent prognostic factor in melanoma. Methods: Our prospective institutional review board (IRB)-approved database was queried for stage III patients with computed tomography (CT) scans at time of lymph node dissection (LND). Psoas area (PA) and density (PD) were determined in semi-automated fashion. Kaplan-Meier (K-M) survival estimates and Cox proportional-hazard models were used to determine PA and PD impact on survival and surgical complications. Results: Among 101 stage III patients, PD was significantly associated with both disease-free survival (DFS) (P=0.04) and distant disease-free survival (DDFS) (P=0.0002). Cox multivariate modeling incorporating thickness, age, ulceration, and N stage showed highly significant association with PD and both DFS and DDFS. DDFS was significantly associated with Breslow thickness (P=0.04), number of positive nodes (P=0.001), ulceration (P=0.04), and decreasing muscle density (P=0.01), with hazard ratio of 0.55 [95% confidence interval (CI) 0.35-0.87]. PD also correlated with surgical complications, with odds ratio (OR) of 1.081 [95% CI 1.016-1.150, P=0.01]. Conclusions: Decreased psoas muscle density on CT, an objective measure of frailty, was as important a predictor of outcome as tumor factors in a cohort of stage III melanoma patients. On multivariate analysis, frailty, not age, was associated with decreased disease-free survival and distant disease-free survival, and higher rate of surgical complications. Society of Surgical Oncology, 2011 Sabel Michael Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut Lee Jay Departments of Biostatistics, University of Michigan, Ann Arbor, MI, USA aut Cai Shijie Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut Englesbe Michael Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut Holcombe Stephen Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut Wang Stewart Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut Annals of Surgical Oncology Springer-Verlag 18/13(2011-12-01), 3579-3585 1068-9265 18:13<3579 2011 18 10434 https://doi.org/10.1245/s10434-011-1976-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1976-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sabel Michael Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Lee Jay Departments of Biostatistics, University of Michigan, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Cai Shijie Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Englesbe Michael Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Holcombe Stephen Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Wang Stewart Departments of Surgery, University of Michigan, Ann Arbor, MI, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/13(2011-12-01), 3579-3585 1068-9265 18:13<3579 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer