首页 > 期刊杂志 > 正文

A Novel Numerical Scoring System for Melanoma Tumor-infiltrating Lymphocytes Has Better Prognostic Value Than Standard Scoring.

恶性黑色素瘤中肿瘤浸润淋巴细胞的一种新型数值评分系统相比标准评分系统具有更好的预后判断价值

Saldanha G,Flatman K,Teo KW,Bamford M

Abstract

The purpose of this study was to evaluate the prognostic value of tumor-infiltrating lymphocytes (TILs) in melanoma and to determine whether a simpler numerical scoring system would be more effective. In total, 655 patients presenting to a UK teaching hospital with primary invasive melanoma were analyzed. TILs were rescored using the standard Clark's method and univariable and multivariable analyses of the effect of TILs on overall survival (OS), disease-specific survival (DSS), and metastasis-free survival (MFS) was assessed using Cox regression. In total, 30 (5%) melanomas showed absent, 464 (71%) nonbrisk, and 161 (24%) brisk TILs. There was a statistically significant relationship between TILs and Breslow thickness, age, melanoma type, mitotic rate, and histologic regression. TIL grade was a significant predictor of MFS in multivariable analysis (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.25-0.77) but was not significant for OS or DSS. By contrast, when a simple numerical TIL percentage score was used this was a strong predictor of OS (HR, 0.55; 95% CI, 0.38-0.78), DSS (HR, 0.25; 95% CI, 0.14-0.44), and MFS (HR, 0.32; 95% CI, 0.21-0.51) in multivariable analysis. The percentage TIL score was also significant when adjusted for the prognostic gold standard, American Joint Committee on Cancer stage: OS (HR, 0.66; 95% CI, 0.46-0.95), DSS (HR, 0.33; 95% CI, 0.19-0.60), and MFS (HR, 0.41; 95% CI, 0.26-0.65). The TIL percentage score was subsequently validated in new cases. In summary, this study strongly confirms that higher amounts of TILs are associated with better prognosis and in addition demonstrates the value of a simplified numerical TIL scoring system.

摘要

本研究将评估肿瘤浸润淋巴细胞(TIL)在黑色素瘤中的预后价值,并比较一种更为简洁的数值评分系统和现有标准评分系统对黑色素瘤的预后预测效力。研究共纳入655位在英国教学医院就诊的原发性侵袭性黑色素瘤患者进行统计分析。对这些患者标本的肿瘤浸润淋巴细胞用标准Clark's法重新评分,就TIL 对总生存(OS)和疾病生存(DSS)的影响行单、多因素分析,并用cox回归模型评估其对无转移生存MFS的影响。所有黑色素瘤标本中,有305%)例TIL 几乎不可见,464 (71%) 例分布稀疏,161 (24%)TIL聚集活跃。TIL的密度与黑色素瘤Breslow浸润深度分级、患者年龄、黑色素瘤的类型、核分裂和组织学消退具有统计学上的显著相关性。多因素分析显示标准TIL分级是黑色素瘤患者无转移生存的独立预测因子 (HR 0.44 95% CI 0.25-0.77) ,但对OS DSS的预测并未发现统计学意义;然而简单的TIL比例数值评分却在多因素分析中显示出对于OS (HR, 0.55; 95% CI, 0.38-0.78), DSS (HR, 0.25; 95% CI, 0.14-0.44),MFS (HR, 0.32; 95% CI, 0.21-0.51)均有较强的预测作用。进一步调整对预后有明确影响的AJCC分期因素后,TIL比例评分对OS (HR, 0.66; 95% CI, 0.46-0.95)DSS (HR, 0.33; 95% CI, 0.19-0.60)MFS (HR, 0.41; 95% CI, 0.26-0.65)的预测依然具有统计学意义。随后在新的病例中TIL比例评分也证实了其有效性。综上,本研究证明黑色素瘤中TILs 的数量与预后正相关,并证实了简化的TIL 数值评分系统对于预后判断具有重要价值。


full text

我要评论

0条评论