Outcomes for smokers who develop melanoma: a systematic review and meta-analysis
Bibliographic record
Abstract
Background There is compelling evidence that the incidence of melanoma in cigarette smokers is substantially lower than in non-smokers. However, the risks of both recurrence and death appear to be higher in smokers if melanoma does develop. The magnitude of these increased risks is poorly documented. This systematic review aimed to analyse melanoma survival outcomes among smokers compared to never-smokers using published studies, and report the magnitude of any survival differences. Methods Searches of Medline, Embase and Cochrane CENTRAL (to 11/03/2024) using terms for melanoma and smoking were conducted. Included studies were those reporting outcomes including disease severity at presentation, risk of death or adverse effects from treatment in smokers and never-smokers with melanoma. No study design or language restrictions were imposed. Risk of bias was assessed using the Newcastle–Ottawa tool. The review protocol was registered with PROSPERO (ID CRD42024518505). Findings Forty-six studies involving 164,166 melanoma patients, of whom 70,766 had smoked cigarettes, were identified. The pooled individual Hazard Ratios (HR) from multivariable analyses, showed that death from melanoma was 33% higher in current compared to never-smokers (HR 1.33, 95% CI 1.14–1.55, p = 0.0002, 13,971+ patients) with limited heterogeneity (I 2 11%). However, former-smokers and never-smokers had very similar rates of death from melanoma (HR 1.04, 95% CI 0.94–1.14, p = 0.52, 16,307+ patients) with moderate heterogeneity (I 2 63%). From univariable analyses, current-smokers had a higher risk of sentinel node-positivity compared to never-smokers (HR 1.35 95% CI 1.13, 1.62, p = 0.001, 5163 patients). Ever-smokers had a greater risk of complications from sentinel node biopsy (Odds Ratio (OR) 2.0 95% CI 1.41–2.85, p = 0.0001, 3745 patients) and lymph node dissection (OR 1.7, 95% CI 1.23–2.20, p = 0.0007, 4596 patients) than never-smokers based on risks from multivariable analyses. Interpretation Current smokers are more likely to die from their melanoma than never-smokers, while former-smokers appear to have similar risks to never-smokers. Smokers have higher risks of sentinel node-positivity and of complications from node surgery. Study limitations included reliance on self-reporting of smoking status. In only seven studies did patients receive modern systemic therapies, limiting the ability to assess their relative efficacy in smokers and non-smokers. Funding None.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.023 | 0.006 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".