TY - JOUR
T1 - Is the presence of tumor-infiltrating lymphocytes predictive of outcomes in patients with melanoma?
AU - for the Sentinel Lymph Node Working Group
AU - Morrison, Steven L.
AU - Han, Gang
AU - Elenwa, Faith
AU - Vetto, John T.
AU - Fowler, Graham
AU - Leong, Stanley P.
AU - Kashani-Sabet, Mohammed
AU - Pockaj, Barbara A.
AU - Kosiorek, Heidi E.
AU - Zager, Jonathan S.
AU - Sondak, Vernon K.
AU - Messina, Jane L.
AU - Mozzillo, Nicola
AU - Schneebaum, Schlomo
AU - Han, Dale
N1 - Publisher Copyright:
© 2022 American Cancer Society
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Background: The significance of tumor-infiltrating lymphocytes (TILs) in melanoma is debated. This article presents a multicenter, retrospective study assessing the predictive and prognostic value of TILs. Methods: The Sentinel Lymph Node Working Group database was queried from 1993 to 2018 for cases with known TIL data. TILs were categorized as absent or present, which included nonbrisk (NB), brisk (B), and present but unspecified TIL levels. Clinicopathologic factors were correlated with TILs, sentinel lymph node (SLN) status, and melanoma-specific survival (MSS). Results: Overall, 3203 patients were included. The median thickness was 1.5 mm, and 469 cases had SLN metastases. TILs were present in 2458 cases (76.7%), with NB, B, and unspecified TILs seen in 1691 (68.8%), 691 (28.1%), and 76 (3.1%), respectively. Multivariable analysis showed that the presence of TILs significantly predicted a negative SLN biopsy (P <.05). The median follow-up was 25.2 months. MSS was significantly better for cases with TILs than cases without TILs (P <.001). According to multivariable analysis, age, gender, thickness, mitotic rate, ulceration, lymphovascular invasion, and SLN status were significantly prognostic of MSS (all P values <.05). Although TILs were not prognostic of MSS, when multiple imputation was used and the SLN status was excluded, the presence of TILs was significantly prognostic of improved MSS (hazard ratio, 0.78; 95% confidence interval, 0.64-0.95; P =.0154). Conclusions: TILs are a favorable marker because their presence significantly predicts a negative SLN, and the absence of TILs may be a prognostic marker of worse survival in patients with a positive SLN but not a negative SLN. TILs may also serve as a prognostic marker of survival when the SLN status is not considered.
AB - Background: The significance of tumor-infiltrating lymphocytes (TILs) in melanoma is debated. This article presents a multicenter, retrospective study assessing the predictive and prognostic value of TILs. Methods: The Sentinel Lymph Node Working Group database was queried from 1993 to 2018 for cases with known TIL data. TILs were categorized as absent or present, which included nonbrisk (NB), brisk (B), and present but unspecified TIL levels. Clinicopathologic factors were correlated with TILs, sentinel lymph node (SLN) status, and melanoma-specific survival (MSS). Results: Overall, 3203 patients were included. The median thickness was 1.5 mm, and 469 cases had SLN metastases. TILs were present in 2458 cases (76.7%), with NB, B, and unspecified TILs seen in 1691 (68.8%), 691 (28.1%), and 76 (3.1%), respectively. Multivariable analysis showed that the presence of TILs significantly predicted a negative SLN biopsy (P <.05). The median follow-up was 25.2 months. MSS was significantly better for cases with TILs than cases without TILs (P <.001). According to multivariable analysis, age, gender, thickness, mitotic rate, ulceration, lymphovascular invasion, and SLN status were significantly prognostic of MSS (all P values <.05). Although TILs were not prognostic of MSS, when multiple imputation was used and the SLN status was excluded, the presence of TILs was significantly prognostic of improved MSS (hazard ratio, 0.78; 95% confidence interval, 0.64-0.95; P =.0154). Conclusions: TILs are a favorable marker because their presence significantly predicts a negative SLN, and the absence of TILs may be a prognostic marker of worse survival in patients with a positive SLN but not a negative SLN. TILs may also serve as a prognostic marker of survival when the SLN status is not considered.
KW - melanoma
KW - nodal metastasis
KW - sentinel lymph node biopsy
KW - staging
KW - survival
KW - tumor-infiltrating lymphocytes (TILs)
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U2 - 10.1002/cncr.34013
DO - 10.1002/cncr.34013
M3 - Article
C2 - 35103302
AN - SCOPUS:85123913152
SN - 0008-543X
VL - 128
SP - 1418
EP - 1428
JO - Cancer
JF - Cancer
IS - 7
ER -