Piras Franca, Colombari Romano, Minerba Luigi, Murtas Daniela, Floris Carlo, Maxia Cristina, Corbu Arianna, Perra M Teresa, Sirigu Paola
Department of Cytomorphology, University of Cagliari, Italy.
Cancer. 2005 Sep 15;104(6):1246-54. doi: 10.1002/cncr.21283.
To establish the prognostic value of immune system cells that infiltrate melanoma, the authors evaluated the distribution and density of T lymphocyte subsets, macrophages, and dendritic cells in samples of primary cutaneous melanoma from 47 patients with Stage I and II melanoma according to the American Joint Committee on Cancer staging system.
Immunohistochemical demonstrations of CD8 and CD4 lymphocytes, CD68 macrophages, human leukocyte antigen-D-related (HLA-DR) cells, S-100 protein, and melanoma-associated antigens Melan A and HMB-45 were performed. The results were derived from independent histopathologic reviews by two pathologists. The low-density, moderate-density, and high-density groups of cells that infiltrated the base of the tumor during the vertical growth phase were compared with the overall survival rate using the Kaplan-Meier method and the log-rank test. Clinical variables (gender, age, tumor location, Clark level, vascular/lymphatic invasion, and thickness) also were analyzed.
The CD8 lymphocytes exhibited independent statistically positive significance in survival (log-rank test, 8.49; P = 0.01) between patients in different lymphocyte density groups. There was a difference in 5-year survival among patients in the high-density group (78.8%), the moderate-density group (44.4%), and the low-density group (25.0%). The CD4 lymphocytes, which were less numerous than CD8 cells, had similar distribution. There also was a correlation of HLA-DR cells with overall survival (log-rank test, 5.29; P = 0.02). CD68 cell density was not found to be correlated with survival.
The presence and number of infiltrating CD8 lymphocytes as well as the overall occurrence of HLA-DR cells may be considered independent, favorable prognostic factors in melanoma. The current results may be important for identifying other prognostic factors with which to evaluate disease progression and develop immune therapies for patients with melanoma.
为确定浸润黑色素瘤的免疫系统细胞的预后价值，作者根据美国癌症联合委员会分期系统，评估了47例Ⅰ期和Ⅱ期原发性皮肤黑色素瘤患者样本中T淋巴细胞亚群、巨噬细胞和树突状细胞的分布及密度。
进行了CD8和CD4淋巴细胞、CD68巨噬细胞、人类白细胞抗原-D相关（HLA-DR）细胞、S-100蛋白以及黑色素瘤相关抗原Melan A和HMB-45的免疫组化检测。结果来自两位病理学家的独立组织病理学评估。使用Kaplan-Meier法和对数秩检验，比较垂直生长期浸润肿瘤基底的低密度、中密度和高密度细胞组与总生存率。还分析了临床变量（性别、年龄、肿瘤位置、Clark分级、血管/淋巴管侵犯和厚度）。
不同淋巴细胞密度组患者之间，CD8淋巴细胞在生存方面表现出独立的统计学阳性意义（对数秩检验，8.49；P = 0.01）。高密度组（78.8%）、中密度组（44.4%）和低密度组（25.0%）患者的5年生存率存在差异。数量少于CD8细胞的CD4淋巴细胞分布相似。HLA-DR细胞与总生存率也存在相关性（对数秩检验，5.29；P = 0.02）。未发现CD68细胞密度与生存相关。
浸润性CD8淋巴细胞的存在和数量以及HLA-DR细胞的总体出现情况，可能被视为黑色素瘤独立的、良好的预后因素。目前的结果对于识别其他预后因素可能很重要，这些因素可用于评估疾病进展并为黑色素瘤患者开发免疫疗法。
