Local Immune Response Predicts Survival in Patients with Thick (T4) Melanomas

Cintolo, Jessica A.; Gimotty, Phyllis A.; Blair, Anne; Guerry, DuPont; Elder, David E.; Hammond, Rachel; Elenitsas, Rosalie; Xu, Xiaowei; Fraker, Douglas L.; Schuchter, Lynn M.; Czerniecki, Brian J.; Karakousis, Giorgos C.

doi:10.1245/s10434-013-3086-3

Cited by 20 publications

(13 citation statements)

References 54 publications

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“…Cintolo and colleagues (33) recently reported on 161 patients and determined the influence of TILs and tumor regression in patients evaluated by the standard parameters including the AJCC staging criteria. The tumors had a median thickness of 5.27 mm.…”

Section: Present and Future Histopathology Studies Of Tils In Melanomamentioning

confidence: 99%

Reflections on the Histopathology of Tumor-Infiltrating Lymphocytes in Melanoma and the Host Immune Response

Mihm

Mulé

2015

Cancer Immunology Research

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In the last five decades the role for lymphocytes in host immune response to tumors has been shown, at least in some patients, to be a critical component in disease prognosis. Also, the heterogeneity of lymphocytes has been documented including the existence of regulatory T cells that suppress the immune response. As the functions of lymphocytes have become better defined in terms of antitumor immunity, specific targets on lymphocytes have been uncovered. The appreciation of the role of immune-checkpoints has also led to therapeutic approaches that illustrate the effectiveness of blocking negative regulators of the antitumor immune response. In this Masters of Immunology article, we trace the evolution of our understanding of tumor-infiltrating lymphocytes and discuss their role in melanoma prognosis from the very basic observation of their existence to the latest manipulation of their functions with the result of improvement of the host response against the tumor.

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Section: Present and Future Histopathology Studies Of Tils In Melanomamentioning

confidence: 99%

Reflections on the Histopathology of Tumor-Infiltrating Lymphocytes in Melanoma and the Host Immune Response

Mihm

Mulé

2015

Cancer Immunology Research

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“…Studies of associations between partial tumor regression and metastasis or survival have produced mixed results, however, with some showing improved outcome( 9 , 10 ) and others showing worse outcome. ( 11 – 13 )…”

Section: Introductionmentioning

confidence: 99%

The influence of tumor regression, solar elastosis, and patient age on pathologists' interpretation of melanocytic skin lesions

Titus

Barnhill

Lott

et al. 2017

Laboratory Investigation

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It is not known whether patient age or tumor characteristics such as tumor regression or solar elastosis influence pathologists’ interpretation of melanocytic skin lesions. We undertook a study to determine the influence of these factors, and to explore pathologist characteristics associated with the direction of diagnosis. To meet our objective, we designed a cross-sectional survey study of pathologists’ clinical practices and perceptions. Pathologists were recruited from diverse practices in ten states in the U.S. We enrolled 207 pathologist participants whose practice included the interpretation of melanocytic skin lesions.Our findings indicated that the majority of pathologists (54.6%) were influenced toward a less severe diagnosis when patients were <30 years of age. Most pathologists were influenced toward a more severe diagnosis when patients were >70 years of age, or by the presence of tumor regression or solar elastosis (58.6%, 71.0%, 57.0%, respectively). Generally, pathologists with dermatopathology board certification and/or a high caseload of melanocytic skin lesions were more likely to be influenced, while those with more years’ experience interpreting MSL were less likely to be influenced. Our findings indicate that the interpretation of melanocytic skin lesions is influenced by patient age, tumor regression, and solar elastosis; such influence is associated with dermatopathology training and higher caseload, consistent with expertise and an appreciation of lesion complexity.

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“…The interaction between present TIL and absent regression may be indicative of an effective immune response and has previously been associated with longer disease-specific survival in patients with thick melanomas. 21 That TIL in the absence of regression is also associated with a low risk of nodal metastasis in intermediate melanoma supports the concept that the interaction of these factors is relevant to patient prognosis.…”

Section: Discussionmentioning

confidence: 54%

Identification of Patients with Intermediate Thickness Melanoma at Low Risk for Sentinel Lymph Node Positivity

et al. 2015

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Introduction Sentinel lymph node (SLN) biopsy is recommended for all patients with intermediate thickness melanomas. We sought to identify such patients at low risk of SLN positivity. Methods All patients with intermediate thickness melanomas (1.01–4 mm) undergoing SLN biopsy at a single institution from 1995–2011 were included in this retrospective cohort study. Univariate and multivariate logistic regression determined factors associated with a low risk of SLN positivity. Classification and regression tree (CART) analysis was used to stratify groups based on risk of positivity. Results Of the 952 study patients, 157 (16.5%) had a positive SLN. In the multivariate analysis, thickness <1.5 mm (OR= 0.29), age ≥60 (OR=0.69), present tumor infiltrating lymphocytes (TIL) (OR=0.60), absent lymphovascular invasion (LVI) (OR=0.46), and absent satellitosis (OR=0.44) were significantly associated with a low risk of SLN positivity. CART analysis identified thickness of 1.5 mm as being the primary cut point for risk of SLN metastasis. Patients with a thickness of <1.5 mm represented 36% of the total cohort and had a SLN positivity rate of 6.6% (95% CI=3.8–9.4%). In patients with melanomas <1.5 mm in thickness, the presence of additional low risk factors identified 257 patients (75% of patients with <1.5 mm melanomas) in which the rate of SLN positivity was <5%. Discussion Despite a SLN positivity rate of 16.5% overall, substantial heterogeneity of risk exists among patients with intermediate thickness melanoma. Most patients with melanoma between 1.01–1.5 mm have a risk of SLN positivity similar to that in patients with thin melanomas.

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Local Immune Response Predicts Survival in Patients with Thick (T4) Melanomas

Cited by 20 publications

References 54 publications

Reflections on the Histopathology of Tumor-Infiltrating Lymphocytes in Melanoma and the Host Immune Response

Reflections on the Histopathology of Tumor-Infiltrating Lymphocytes in Melanoma and the Host Immune Response

The influence of tumor regression, solar elastosis, and patient age on pathologists' interpretation of melanocytic skin lesions

Identification of Patients with Intermediate Thickness Melanoma at Low Risk for Sentinel Lymph Node Positivity

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