Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3610–3617

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

Authors

  • Jessica A. Cintolo
    • Department of SurgeryUniversity of Pennsylvania
    • Harrison Department of Surgical ResearchUniversity of Pennsylvania
  • Phyllis Gimotty
    • Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of MedicineUniversity of Pennsylvania
  • Anne Blair
    • Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of MedicineUniversity of Pennsylvania
  • DuPont Guerry
    • Abramson Cancer Center, Perelman School of MedicineUniversity of Pennsylvania
  • David E. Elder
    • Anatomic Pathology Division, Department of Pathology and Laboratory Medicine, Perelman School of MedicineUniversity of Pennsylvania
  • Rachel Hammond
    • Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of MedicineUniversity of Pennsylvania
  • Rosalie Elenitsas
    • Department of Dermatology, Perelman School of MedicineUniversity of Pennsylvania
  • Xiaowei Xu
    • Anatomic Pathology Division, Department of Pathology and Laboratory Medicine, Perelman School of MedicineUniversity of Pennsylvania
  • Douglas Fraker
    • Department of SurgeryUniversity of Pennsylvania
    • Harrison Department of Surgical ResearchUniversity of Pennsylvania
    • Abramson Cancer Center, Perelman School of MedicineUniversity of Pennsylvania
  • Lynn M. Schuchter
    • Abramson Cancer Center, Perelman School of MedicineUniversity of Pennsylvania
    • Department of Hematology and Oncology, Department of Medicine, Perelman School of MedicineUniversity of Pennsylvania
  • Brian J. Czerniecki
    • Department of SurgeryUniversity of Pennsylvania
    • Harrison Department of Surgical ResearchUniversity of Pennsylvania
    • Abramson Cancer Center, Perelman School of MedicineUniversity of Pennsylvania
    • Department of SurgeryUniversity of Pennsylvania
    • Harrison Department of Surgical ResearchUniversity of Pennsylvania
    • Abramson Cancer Center, Perelman School of MedicineUniversity of Pennsylvania
Melanomas

DOI: 10.1245/s10434-013-3086-3

Cite this article as:
Cintolo, J.A., Gimotty, P., Blair, A. et al. Ann Surg Oncol (2013) 20: 3610. doi:10.1245/s10434-013-3086-3

Abstract

Background

Tumor infiltrating lymphocytes (TIL) and histological regression in primary melanoma are generally considered indicators of the local immune response but their roles as prognostic factors have been variably reported. We examined the prognostic role of these variables in patients with high risk (T4) primary melanomas in a large series of patients with long-term follow-up.

Methods

From a prospectively maintained cohort of patients diagnosed between 1971 and 2004, 161 patients were retrospectively identified with primary thick melanomas (>4 mm), no clinical evidence of regional nodal disease (RND) at diagnosis and complete histopathologic data. Univariate and multivariate Cox regression models were performed to identify clinical and histopathologic predictors of disease-specific survival (DSS) and to identify subgroups with differential survival.

Results

Factors significantly associated with decreased DSS by univariate analysis included male gender, age ≥ 60 years, axial anatomic location, presence of ulceration, RND, absence of TIL, and presence of regression. In the final multivariate model, TIL and regression, as interacting variables, and RND status remained significantly associated with DSS. In the presence of TIL, concomitant regression was associated with significantly worse survival (p ≤ 0.0001). In the absence of TIL, there was no effect of regression on survival (p = 0.324).

Conclusions

Primary TIL and regression status and RND status are independently associated with melanoma-specific survival in patients with T4 melanomas; presence of TIL in the primary melanoma with concomitant radial growth phase regression is associated with a poor prognosis and may reflect an ineffective local regional immune response.

Copyright information

© Society of Surgical Oncology 2013