Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Melanoma Res. 2013 Apr;23(2):132-7. doi: 10.1097/CMR.0b013e32835e5880.
Tumor-infiltrating lymphocytes (TILs) and regression are manifestations of the host immune response to tumor, but their influence on outcome remains undefined. There is a paucity of data on the elderly who represent a growing proportion of melanoma patients. The aim of this study was to evaluate the influence of TILs and regression as an indirect measure of immunity on outcome in elderly patients with melanoma. From a prospective database, we identified 250 consecutive cutaneous melanoma patients aged at least 65 years at the time of diagnosis. Data were verified by record review. Within the primary melanoma, a brisk TIL response was present in 66 (31%), nonbrisk TILs in 36 (17%), and absent in 111 (52%). The presence of a brisk infiltrate conferred a three-fold increased risk of sentinel lymph node (SLN) metastasis (P=0.02). Despite this, nonbrisk or absent TILs were associated with a five-fold increased risk of recurrence (P=0.0001). In multivariate analysis, nonbrisk or absent TILs were independently associated with recurrence (P<0.0001), diminished 5-year disease-free survival (76 vs. 91%, P=0.0006), and 5-year melanoma-specific survival (82 vs. 95%, P=0.0008). Regression was not an independent predictor of SLN metastasis, disease-free survival, or melanoma-specific survival. Our study demonstrates that an active antitumor immune response exists in elderly melanoma patients that, paradoxically, predicts both SLN metastasis and improved melanoma-specific outcomes. Further investigation to characterize this lymphocytic infiltrate and to confirm its clinical significance as a predictor of nodal status, patient outcome, and response to immunotherapy in elderly melanoma patients appears warranted.
肿瘤浸润淋巴细胞（TILs）和消退是宿主对肿瘤免疫反应的表现，但它们对结局的影响仍不清楚。老年人的数据很少，而他们在黑色素瘤患者中所占的比例越来越大。本研究旨在评估 TILs 和消退作为免疫的间接指标对老年黑色素瘤患者结局的影响。我们从一个前瞻性数据库中确定了 250 例连续的皮肤黑色素瘤患者，他们在诊断时年龄均至少为 65 岁。通过记录审查对数据进行了验证。在原发性黑色素瘤中，有 66 例（31%）存在活跃的 TIL 反应，36 例（17%）存在非活跃的 TIL 反应，111 例（52%）不存在 TIL 反应。存在活跃浸润使前哨淋巴结（SLN）转移的风险增加三倍（P=0.02）。尽管如此，非活跃或不存在 TILs 与复发风险增加五倍相关（P=0.0001）。在多变量分析中，非活跃或不存在 TILs 与复发独立相关（P<0.0001），降低了 5 年无病生存率（76%比 91%，P=0.0006）和 5 年黑色素瘤特异性生存率（82%比 95%，P=0.0008）。消退不是 SLN 转移、无病生存率或黑色素瘤特异性生存率的独立预测因素。我们的研究表明，老年黑色素瘤患者存在活跃的抗肿瘤免疫反应，这种反应矛盾地预测了 SLN 转移和改善的黑色素瘤特异性结局。进一步的研究来描述这种淋巴细胞浸润，并确认其作为淋巴结状态、患者结局和老年黑色素瘤患者免疫治疗反应的预测因素的临床意义似乎是有必要的。
