title: The predictive value of CD8, CD4, CD68, and human leukocyte antigen-D-related cells in the prognosis of cutaneous malignant melanoma with vertical growth phase.
abstract: BACKGROUND
  To establish the prognostic value of immune system cells that infiltrate melanoma, the authors evaluated the distribution and density of T lymphocyte subsets, macrophages, and dendritic cells in samples of primary cutaneous melanoma from 47 patients with Stage I and II melanoma according to the American Joint Committee on Cancer staging system.
  
  
  METHODS
  Immunohistochemical demonstrations of CD8 and CD4 lymphocytes, CD68 macrophages, human leukocyte antigen-D-related (HLA-DR) cells, S-100 protein, and melanoma-associated antigens Melan A and HMB-45 were performed. The results were derived from independent histopathologic reviews by two pathologists. The low-density, moderate-density, and high-density groups of cells that infiltrated the base of the tumor during the vertical growth phase were compared with the overall survival rate using the Kaplan-Meier method and the log-rank test. Clinical variables (gender, age, tumor location, Clark level, vascular/lymphatic invasion, and thickness) also were analyzed.
  
  
  RESULTS
  The CD8 lymphocytes exhibited independent statistically positive significance in survival (log-rank test, 8.49; P = 0.01) between patients in different lymphocyte density groups. There was a difference in 5-year survival among patients in the high-density group (78.8%), the moderate-density group (44.4%), and the low-density group (25.0%). The CD4 lymphocytes, which were less numerous than CD8 cells, had similar distribution. There also was a correlation of HLA-DR cells with overall survival (log-rank test, 5.29; P = 0.02). CD68 cell density was not found to be correlated with survival.
  
  
  CONCLUSIONS
  The presence and number of infiltrating CD8 lymphocytes as well as the overall occurrence of HLA-DR cells may be considered independent, favorable prognostic factors in melanoma. The current results may be important for identifying other prognostic factors with which to evaluate disease progression and develop immune therapies for patients with melanoma.
authors.affiliation: Department of Cytomorphology, University of Cagliari, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Piras
authors.forename: Romano
authors.initials: R
authors.lastname: Colombari
authors.forename: Luigi
authors.initials: L
authors.lastname: Minerba
authors.forename: Daniela
authors.initials: D
authors.lastname: Murtas
authors.forename: Carlo
authors.initials: C
authors.lastname: Floris
authors.forename: Cristina
authors.initials: C
authors.lastname: Maxia
authors.forename: Arianna
authors.initials: A
authors.lastname: Corbu
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Perra
authors.forename: Paola
authors.initials: P
authors.lastname: Sirigu
mesh_terms: D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000032:analysis*; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis*; D015704:CD4 Antigens / Q000032:analysis*; D016827:CD8 Antigens / Q000032:analysis*; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000276:immunology* / Q000401:mortality; D008875:Middle Aged; D011379:Prognosis; D012878:Skin Neoplasms / Q000276:immunology* / Q000401:mortality; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015704:CD4 Antigens; D016827:CD8 Antigens; D006684:HLA-DR Antigens; C067980:CD68 antigen, human; D000097382:CD68 Molecule