美国外科病理学杂志 | 新的恶性黑色素瘤肿瘤浸润性淋巴细胞数值评分系统比标准化评分系统有更好的预测价值

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  ——本文经《美国外科病理学杂志》授权发布,其他媒体转载或引用须经《美国外科病理学杂志》同意,否则追究法律责任。

  摘要
  本研究旨在评估肿瘤浸润性淋巴细胞(tumor-infiltrating lymphocytes,TILs)在恶性黑色素瘤中的预后价值,并探讨简化的数值评分系统是否更为有效。共收集并分析英国一家教学医院的原发侵袭性恶性黑色素瘤患者655例。使用标准化Clark预后模型重新评估TILs,并使用Cox回归模型评估TILs在单因素及多因素分析中对总生存期(overall survival,OS),疾病特异性生存期(disease-specific survival,DSS)和无转移生存期(metastasis-free survival,MFS)的影响。其中,30例(5%)恶性黑色素瘤不存在TILs,464例(71%)TILs不活跃,161例(24%)TILs活跃。TILs与Breslow厚度、年龄、恶性黑色素瘤亚型、核分裂象和组织学出现退化均有统计学相关性。在多因素分析中,TIL分级是MFS的独立预后指标[风险比(hazard ratio,HR),0.44;95%置信区间(confidence interval,Cl),0.25~0.77],但并非OS或DSS的独立预后指标。简单数值TIL百分比评分是OS(HR,0.55;95%CI,0.38~0.78)、DSS(HR,0.25;95%CI,0.14~0.44)和MFS(HR,0.32;95%CI,0.21~0.51)强有力的多因素预后指标。用预后金标准,美国癌症联合委员会癌症分期校正后,TIL百分比评分仍是OS(HR,0.66;95%CI,0.46~0.95)、DSS(HR,0.33;95%CI,0.19~0.60)和MFS(HR,0.41;95%CI,0.26~0.65)的预后指标。在随后的新病例中验证了TIL百分比评分的预后价值。总之,本研究有力地证实TILs高表达与较好的预后相关,并且证明了简化数值TIL评分系统的价值。
  来源:Am J Surg Pathol 2017;41:906–914
  美国外科病理学杂志中文版2018年第一期摘要No.1
  (吕矫洁 翻译;王坚 审校)
  The American Journal of Surgical Pathology中文版声明:
  @2018 Wolters Kluwer Health
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