title: BILLCD8 - A Multivariable Survival Model as a Simple and Clinically Useful Prognostic Tool to Identify High-risk Cutaneous Melanoma Patients.
abstract: To develop a multivariable survival model based on histopathological parameters that would provide the best possible estimate of the risk of death in cutaneous melanoma patients.
  
  
  
  Breslow thickness and Infiltrating Lymphocytes (BILL(CD8)) is based on two key parameters, namely Breslow thickness and tumor-infiltrating lymphocytes (TILs) shown to be the most important prognostic factors using logistic regression model. The next step was to apply a decision tree method to analyze the impact of the percentage of CD8+ lymphocytes on the risk of cancer death.
  
  
  
  A patient is given two points if Breslow thickness is >2 mm and one point if TILs are not found in the tumor. The probability of death over a 4-year follow-up is 75% if the patient's score is 3 points; in patients with 0 point score the risk of death is 0%. A significant positive impact of high percentage of CD8+ lymphocytes on the risk of death was shown in the subgroup of melanoma patients with Breslow thickness >2 mm where the risk of death is only 28%. In the case of low percentage of CD8+ lymphocytes in melanomas with Breslow thickness over 2 mm, the risk is as high as 67%.
  
  
  
  Breslow thickness and TILs, with the evaluation of the CD8+ lymphocytes, may be used for precise prognostic stratification of patients and may help intensify the follow-up, diagnose a relapse sooner and apply proper treatment.
authors.affiliation: Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland piotrdonizy@wp.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Donizy
authors.affiliation: Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Biecek
authors.affiliation: Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Halon
authors.affiliation: Department of Oncology, Wroclaw Medical University, Wroclaw, Poland Lower Silesian Cancer Center, Wroclaw, Poland.
authors.forename: Rafal
authors.initials: R
authors.lastname: Matkowski
mesh_terms: D000328:Adult; D000368:Aged; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D016246:Lymphocytes, Tumor-Infiltrating / Q000276:immunology / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D012878:Skin Neoplasms; D000096142:Cutaneous Malignant Melanoma
keywords: Prognosis; histopathology; malignant melanoma; survival model