Tumor-infiltrating lymphocyte scoring improves progression risk prediction in stage II melanoma: A retrospective cohort study - 18/06/25
, Benedict Reed, MBBS c, Bhavika Khera, MBBS c, Mahaveer Sangha, MBBS d, Simran Thadani, MBBS d, Annika B. Wilder-Smith, MBChB d, Milosz Wojtowicz, MBBS d, Mary Pissaridou, MBBS d, Ameer Mustafa, MBBS d, Eleni Ieremia, MD e, Olivia Espinosa, MBBS e, Jonathan Dunne, MBChB, MSc f, Fadi Issa, DPhil a, b, d, Oliver Cassell, MBChB b, cAbstract |
Background |
The American Joint Committee on Cancer eighth edition substaging might be suboptimal for predicting melanoma progression. Using it to select stage II patients for adjuvant immunotherapy risks overtreating low-risk stage IIB/IIC patients and undertreating high-risk stage IIA patients. Prognostic capability of tumor-infiltrating lymphocytes (TILs) is unclear in stage II melanoma.
Objective |
To evaluate the American Joint Committee on Cancer eighth edition substaging and TIL scoring as predictors of progression in stage II melanoma.
Methods |
Retrospective cohort study of 366 sentinel lymph node negative stage II melanoma patients from 4 UK hospitals (2004-2017), with long-term follow-up.
Results |
Twenty-three percent of melanomas progressed (median 9.5-year follow-up). Among those, 41.5% were stage IIA, 41.5% IIB, and 17.1% IIC. TIL scoring independently predicted progression risk (brisk vs non-brisk: odds ratio: 0.298, P = .009; absent vs non-brisk: odds ratio: 0.436, P = .049) and progression-free survival. Nonbrisk TILs, present in 80% of progressing tumors, denoted high risk. TIL scoring split patients into high and low risk across substages: stage IIA patients with non-brisk TILs had similar 5-year progression-free survival to stage IIB/IIC patients with absent/brisk TILs.
Limitations |
Retrospective study design and unknown generalizability.
Conclusion |
Stage II melanoma progression is poorly predicted by the American Joint Committee on Cancer eighth edition substage. TIL scoring offers improved risk stratification across substages and could serve as a cost-effective method to better identify patients who may benefit from adjuvant immunotherapies.
Le texte complet de cet article est disponible en PDF.Key words : adjuvant immunotherapy, AJCC staging, biomarker, cancer prognosis, cancer staging, immunology, melanoma, oncology, pathology, personalized medicine, prognostic factor, progression-free survival (PFS), progression risk, retrospective cohort study, risk stratification, sentinel lymph node (SLN), skin cancer, stage II melanoma, surgical oncology, tumor-infiltrating lymphocyte (TIL)
Abbreviations used : AJCC, BHT, CI, DMFS, HR, IQR, IRB, MSS, NHS, OR, OUH, PFS, RFS, SLN, SLNB, SLN(−), SLN(+), STROBE, TIL
Plan
| Funding sources: This study is funded by the NIHR Academic Clinical Fellow programme (ACF-2021-13-006). |
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| Patient consent: Not applicable - Informed consent was waived due to the retrospective nature of the study. |
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| IRB approval status: Reviewed by Oxford University Hospitals NHS Foundation Trust & Buckinghamshire Healthcare NHS Trust IRB and exempted from research ethics committee review. |
Vol 93 - N° 1
P. 132-140 - juillet 2025 Retour au numéro
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