Tumor-Infiltrating Lymphocyte Grade Is an Independent Predictor of Sentinel Lymph Node Status and Survival in Patients With Cutaneous Melanoma
Tumor-Infiltrating Lymphocyte Grade Is an Independent Predictor of Sentinel Lymph Node Status and Survival in Patients With Cutaneous Melanoma
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DOI：
10.1200/jco.2011.37.8539
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发表时间：
2012-07-20
影响因子：
45.3
通讯作者：
Thompson, John F.
中科院分区：
文献类型：
--
作者：
Azimi, Farhad;Scolyer, Richard A.;Thompson, John F.
目的探讨肿瘤浸润淋巴细胞的密度和分布（TIL； TIL分级）是否是临床局限性原发性皮肤黑色素瘤患者前哨淋巴结（SLN）状态和生存的独立预测因子。方法从澳大利亚黑色素瘤研究所的数据库中，筛选出1865例厚度为>= 0.75 mm的单一原发性黑色素瘤患者。分析临床和病理因素与SLN状态、无复发生存期（RFS）和黑色素瘤特异性生存期（MSS）的关系。结果大多数患者无TIL （TIL 0级，35.4%）或少量TIL (TIL 1级，45.1%)，少数患者有中度TIL （TIL 2级，16.3%）或显著TIL （TIL 3级，3.2%）。肿瘤厚度、有丝分裂率、Clark水平与TIL分级呈负相关（P < 0.001）。1138例患者（61.0%）进行了SLN活检，252例（22.1%）呈阳性。SLN状态与TIL分级呈显著负相关（各TIL分级的SLN阳性率分别为0,27.8%、1,20.1%、2,18.3%、3,5.6%,P < 0.001）。SLN阳性的预测因子为年龄降低（P < 0.001）、TIL分级降低（P < 0.001）、溃疡（P = 0.003）、肿瘤厚度增加（P = 0.01）、卫星分裂（P = 0.03）、有丝分裂增加（P = 0.03）。5年MSS和RFS率分别为83%和76%（中位随访时间为43个月）。肿瘤厚度（P < .001）、溃疡（P < .001）、卫星分裂（P < .001）、有丝分裂率（P = .003）、TIL分级（P < .001）和性别（P = .01）是MSS的独立预测因素。TIL 3级肿瘤患者的生存率为100%。结论til分级是黑色素瘤患者生存和SLN状态的独立预测因子。有明显TIL浸润的患者预后良好。
PurposeTo determine whether density and distribution of tumor-infiltrating lymphocytes (TILs; TIL grade) is an independent predictor of sentinel lymph node (SLN) status and survival in patients with clinically localized primary cutaneous melanoma.MethodsFrom the Melanoma Institute Australia database, 1,865 patients with a single primary melanoma >= 0.75 mm in thickness were identified. The associations of clinical and pathologic factors with SLN status, recurrence-free survival (RFS), and melanoma-specific survival (MSS) were analyzed.ResultsThe majority of patients had either no (TIL grade 0; 35.4%) or few (TIL grade 1; 45.1%) TILs, with a minority showing moderate (TIL grade 2; 16.3%) or marked (TIL grade 3; 3.2%) TILs. Tumor thickness, mitotic rate, and Clark level were inversely correlated with TIL grade (each P < .001). SLN biopsy was performed in 1,138 patients (61.0%) and was positive in 252 (22.1%). There was a significant inverse association between SLN status and TIL grade (SLN positivity rates for each TIL grade: 0, 27.8%; 1, 20.1%; 2, 18.3%; 3, 5.6%; P < .001). Predictors of SLN positivity were decreasing age (P < .001), decreasing TIL grade (P < .001), ulceration (P = .003), increasing tumor thickness (P = .01), satellitosis (P = .03), and increasing mitoses (P = .03). The 5-year MSS and RFS rates were 83% and 76%, respectively (median follow-up, 43 months). Tumor thickness (P < .001), ulceration (P < .001), satellitosis (P < .001), mitotic rate (P = .003), TIL grade (P < .001), and sex (P = .01) were independent predictors of MSS. Patients with TIL grade 3 tumors had 100% survival.ConclusionTIL grade is an independent predictor of survival and SLN status in patients with melanoma. Patients with a pronounced TIL infiltrate have an excellent prognosis.