Tumor-infiltrating lymphocyte response in cutaneous melanoma in the elderly predicts clinical outcomes

Travis E. Grotz, Faaiza Vaince, Tina J Hieken

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)132-137
Number of pages6
JournalMelanoma Research
Volume23
Issue number2
DOIs
StatePublished - Apr 2013

Fingerprint

Tumor-Infiltrating Lymphocytes
Melanoma
Skin
Neoplasm Metastasis
Disease-Free Survival
Active Immunity
Recurrence
Survival
Immunotherapy
Immunity
Multivariate Analysis
Databases

Keywords

  • active immunity
  • elderly
  • lymphatic metastasis
  • melanoma
  • recurrence
  • sentinel lymph node biopsy
  • survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Dermatology

Cite this

Tumor-infiltrating lymphocyte response in cutaneous melanoma in the elderly predicts clinical outcomes. / Grotz, Travis E.; Vaince, Faaiza; Hieken, Tina J.

In: Melanoma Research, Vol. 23, No. 2, 04.2013, p. 132-137.

Research output: Contribution to journalArticle

@article{87e7c5b27e9943149b455197397d9ca8,
title = "Tumor-infiltrating lymphocyte response in cutaneous melanoma in the elderly predicts clinical outcomes",
abstract = "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.",
keywords = "active immunity, elderly, lymphatic metastasis, melanoma, recurrence, sentinel lymph node biopsy, survival",
author = "Grotz, {Travis E.} and Faaiza Vaince and Hieken, {Tina J}",
year = "2013",
month = "4",
doi = "10.1097/CMR.0b013e32835e5880",
language = "English (US)",
volume = "23",
pages = "132--137",
journal = "Melanoma Research",
issn = "0960-8931",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Tumor-infiltrating lymphocyte response in cutaneous melanoma in the elderly predicts clinical outcomes

AU - Grotz, Travis E.

AU - Vaince, Faaiza

AU - Hieken, Tina J

PY - 2013/4

Y1 - 2013/4

N2 - 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.

AB - 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.

KW - active immunity

KW - elderly

KW - lymphatic metastasis

KW - melanoma

KW - recurrence

KW - sentinel lymph node biopsy

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=84874946383&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874946383&partnerID=8YFLogxK

U2 - 10.1097/CMR.0b013e32835e5880

DO - 10.1097/CMR.0b013e32835e5880

M3 - Article

C2 - 23344159

AN - SCOPUS:84874946383

VL - 23

SP - 132

EP - 137

JO - Melanoma Research

JF - Melanoma Research

SN - 0960-8931

IS - 2

ER -