Prognostic value of tumor infiltrating lymphocytes in the vertical growth phase of primary cutaneous melanoma.
Claudio G. Clemente,F.A.C.P. Martin C. Mihm Jr. M.D.,Rosaria Bufalino,Stefano Zurrida,Paola Collini,Natale Cascinelli +5 more
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TLDR
In an attempt to delineate the histologic diagnostic criteria, to classify different categories of lymphocytic infiltrates, previously described by Elder et al. as brisk, nonbrisk, and absent, and to verify their prognostic significance, 285 consecutive cases of primary cutaneous melanomas are reviewed.Abstract:
BACKGROUND
Primary cutaneous melanoma is often infiltrated by lymphocytes that provide the opportunity to study what may be the local immunologic reaction to the tumor and to correlate the presence of these lymphocytes with overall survival. In an attempt to delineate the histologic diagnostic criteria, to classify different categories of lymphocytic infiltrates, previously described by Elder et al. as brisk, nonbrisk, and absent, and to verify their prognostic significance, we reviewed 285 consecutive cases of primary cutaneous melanomas (American Joint Committee on Cancer Stage I and II).
METHODS
In addition to clinical variables (age, sex, and location of tumor) and the presence of tumor infiltrating lymphocytes in the vertical growth phase, the histopathologic attributes reviewed included mitotic rate, thickness, and regression. The results were derived from independent histopathologic review by two pathologists (C.G.C., M.C.M., Jr.) on separate occasions. A multivariate analysis of survival was performed with the Cox's regression model.
RESULTS
The 5- and 10-year survival rates for melanoma with a vertical growth phase and a brisk infiltrate were 77% and 55%, respectively. For tumors with a nonbrisk infiltrate, the 5- and 10-year survival rates were 53% and 45%, respectively, and for tumors with absent tumor infiltrating lymphocytes, the 5- and 10-year survival rates were 37% and 27%, respectively. Mitotic index, thickness, and tumor infiltrating lymphocytes were statistically (univariate analysis) significant prognostic factors (P = 0.003, 0.000001, 0.0003, respectively), whereas the presence or absence of regression is not. In the univariate statistical analysis, the sex of patients and site of melanoma also were statistically significant (P = 0.00001 and 0.002 respectively), whereas age (P = 0.98) was not statistically significant. The multivariate analysis of thickness, mitotic rate, and tumor infiltrating lymphocytes showed that thickness and presence of tumor infiltrating lymphocytes were significant and independent histologic prognostic factors. With regard to the clinical factors, sex retained its independent prognostic significance. The histologic characteristics of melanoma with vertical growth phase (brisk, nonbrisk, and absent) are exemplified.
CONCLUSIONS
We demonstrated that when categories of tumor infiltrating lymphocytes are strictly defined, they indeed have very strong predictive value for primary cutaneous melanomas with a vertical growth phase. This work confirms the work of Clark et al. and fully illustrates the brisk, nonbrisk, and absent categories of infiltration. Finally, a multivariate analysis comparing thickness, mitotic rate and presence of tumor infiltrating lymphocytes showed that only thickness and presence of tumor infiltrating lymphocytes are significant and independent positive histologic prognostic factors. Cancer 1996;77:1303-10.read more
Citations
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Type, Density, and Location of Immune Cells Within Human Colorectal Tumors Predict Clinical Outcome
Jérôme Galon,Anne Costes,Fátima Sánchez-Cabo,Amos Kirilovsky,Bernhard Mlecnik,Christine Lagorce-Pagès,Marie Tosolini,Matthieu Camus,Anne Berger,Philippe Wind,Franck Zinzindohoué,Patrick Bruneval,Paul-Henri Cugnenc,Zlatko Trajanoski,Wolf H. Fridman,Franck Pagès +15 more
TL;DR: In situ analysis of tumor-infiltrating immune cells may be a valuable prognostic tool in the treatment of colorectal cancer and possibly other malignancies.
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TL;DR: A unifying conceptual framework called “cancer immunoediting,” which integrates the immune system’s dual host-protective and tumor-promoting roles is discussed.
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Cancer immunoediting: from immunosurveillance to tumor escape.
TL;DR: The historical and experimental basis of cancer immunoediting is summarized and its dual roles in promoting host protection against cancer and facilitating tumor escape from immune destruction are discussed.
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The immune contexture in human tumours: impact on clinical outcome
Wolf H. Fridman,Franck Pagès,Catherine Sautès-Fridman,Catherine Sautès-Fridman,Catherine Sautès-Fridman,Jérôme Galon +5 more
TL;DR: In this Opinion article, the context-specific nature of infiltrating immune cells can affect the prognosis of patients is discussed.
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The three Es of cancer immunoediting.
TL;DR: The history of the cancer immunosurveillance controversy is summarized and its resolution and evolution into the three Es of cancer immunoediting--elimination, equilibrium, and escape are discussed.
References
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Model Predicting Survival in Stage I Melanoma Based on Tumor Progression
Wallace H. Clark,David E. Elder,DuPont Guerry,Leonard E. Braitman,Bruce J. Trock,Delray Schultz,Marie Synnestvedt,Allan C. Halpern +7 more
TL;DR: A prognostic model for primary, clinical stage I cutaneous melanoma was developed using the lesional steps in tumor progression and multivariable logistic regression to develop a model that is 89% accurate in predicting survival.
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Prognostic significance of HER-2/NEU expression in breast cancer and its relationship to other prognostic factors
Franco Rilke,Maria I. Colnaghi,Natale Cascinelli,Salvatore Andreola,M T Baldini,Rosaria Bufalino,G. Della Porta,Sylvie Ménard,M. A. Pierotti,A Testori +9 more
TL;DR: Over‐expression of p 185 was found to be related to tumor size and grade and to LPI but not to pathologic nodal status, and showed the same correlation with a poor prognosis as in node‐positive patients.
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Patterns of human tumor-infiltrating lymphocytes in 120 human cancers.
Charles M. Balch,Lee B. Riley,Yoon Joo Bae,Marie A. Salmeron,Chris D. Platsoucas,Andrew C. von Eschenbach,Kyogo Itoh +6 more
TL;DR: There was considerable diversity of tumor-infiltrating lymphocytes among these histologically distinct tumors with respect to magnitude of lymphocyte infiltration, phenotypic expression, and functional capacity.
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The biologic forms of malignant melanoma.
TL;DR: This communication is concerned with some of the attributes that distinguish the four common melanomas: lentigo maligna melanoma, acral lentiginous melanomas, nodula r melanoma; and superficial spreading melanoma.
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Prognostic Index in Malignant Melanoma
TL;DR: The application of this prognostic index seems to be useful in selecting for further treatment stage I melanoma patients with poor prognoses, eg, prophylatic lymph node dissection and immunochemotherapy.
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