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Original research
The prognostic value of tumor-infiltrating lymphocytes in vulvovaginal melanoma
  1. Margaux Vanbockstael1,
  2. Guillaume Bataillon2,
  3. Mathilde Morisseau3,
  4. Gwenael Ferron4,
  5. Justine Attal5,
  6. Thomas Meresse6,
  7. Emilie Tournier7,
  8. Yann Tanguy Le Gac8,
  9. Cécile Pages9 and
  10. Alejandra Martinez4
    1. 1Department of Gynecology, IUCT Oncopole, Toulouse, France
    2. 2Department of Anatomopathology, Toulouse University Cancer Institute, Toulouse, France
    3. 3Department of Biostatistics and Health Data Science Unit, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
    4. 4Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
    5. 5Department of Radiotherapy, Institut Universitaire du Cancer, Toulouse, France
    6. 6Department of Plastic and Reconstructive Surgery, Institut Universitaire du Cancer de Toulouse, Toulouse, France
    7. 7Department of Pathology, Institut Universitaire du Cancer, Toulouse, France
    8. 8Institut Universitaire du Cancer de Toulouse, Toulouse, France
    9. 9Department of Dermatology, Institut Universitaire du Cancer, Toulouse, France
    1. Correspondence to Dr Alejandra Martinez; martinez.alejandra{at}iuct-oncopole.fr

    Abstract

    Objective To assess the relation between immune microenvironment, survival, and clinicopathological characteristics.

    Methods This study was a retrospective, single-center, observational study. Patients with a vulvovaginal melanoma and available archived material were included. All cases underwent pathology review, tumor-infiltrating lymphocyte quantification, and next-generation sequencing analysis, when feasible. Clinical data included demographic, treatment, and prognostic data.

    Results Forty-two patients were selected during the study period, but 13 were finally excluded owing to unavailable formalin-fixed, paraffin-embedded material or unknown follow-up data. Twelve of 19 cases (63.2%) had at least one genetic mutation, 3/18 (16.7%) had BRAF, 3/18 (16.7%) had c-KIT mutation, and 4/17 (23.5%) had NRAS mutations. High stromal tumor-infiltrating lymphocytes were identified in 13/28 patients (46.4%), and brisk tumor-infiltrating lymphocytes in 17/28 patients (60.7%). A density of stromal tumor-infiltrating lymphocytes >40% and brisk distribution were the single clinicopathologic factor associated with increased disease-free survival.

    Conclusion The study showed that brisk tumor-infiltrating lymphocytes and stromal tumor-infiltrating lymphocytes were a marker for disease progression, and for response to immunotherapy strategies. To validate these findings on a larger scale, further research is warranted through a multicenter study with a larger cohort and additional genetic and translational analysis.

    • Melanoma
    • Vulvar and Vaginal Cancer
    • Pathology
    • Vulvar Neoplasms

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    https://doi.org/10.1136/ijgc-2024-005359

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      Data availability statement

      All data relevant to the study are included in the article or uploaded as supplementary information.

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      Footnotes

      • X @Alejandra

      • Contributors MV collected and analysed the data, and wrote the manuscript. AM supervised the writing and coordination of this work, and is the guarantor of the contributorship statement. GB assisted with anatomopathological data collection. CP helped to make the work more complete and provided a dermatological perspective. ET, TM, YTLG, GF, JA reviewed the work to make it more relevant. MM carried out the statistical work.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.