Prognostic role of histological regression in primary cutaneous melanoma: a systematic review and meta-analysis

Abstract

Summary The prognostic significance of histological regression in primary melanoma has been debated for many years. We aim to review the evidence to see how histological regression may affect prognosis. A systematic review was performed by searching in MEDLINE, Scopus and the Cochrane Library from 1 January 1966 to 1 August 2015. All studies reporting hazard ratios or data on survival and histological regression were included. Primary random‐effects meta‐analyses were used to summarize outcome measures. Heterogeneity was assessed using the χ2‐test and I2‐statistic. To assess the potential bias of small studies we used funnel plots and the Begg and Mazumdar adjusted rank correlation method. Summaries of survival outcomes were measured as hazard ratios or relative risk of death at 5 years according to the presence of histological regression of primary melanoma. In total, 183 articles were reviewed out of 1876 retrieved. Ten studies comprising 8557 patients were included. Patients with histological regression had a lower relative risk of death (0·77, 95% confidence interval 0·61–0·97) than those without. Examination of the funnel plot did not provide evidence of publication bias. The results showed that histological regression is a protective factor for survival.

External validation of a prognostic model to predict survival of patients with sentinel node-negative melanoma

“…Another tumour characteristic of interest is regression. Regression has been found to be an independent prognostic factor for patients with melanoma in general. In line with previous studies, independent prognostic value was not proven for SN‐negative melanoma in the present analysis.…”

“…The AJCC acceptance criteria for individualized prognostic models were taken into account when building the model. The following potential prognostic factors were selected based on clinical experience and literature review: sex, age, ulceration, Breslow thickness, primary tumour site, melanoma subtype, Clark level, tumour mitotic rate, regression, number of SN fields and total number of SNs. To address the possibility of a non‐linear association with outcomes, the continuous variables age and Breslow thickness were modelled by logarithmic transformation.…”

Phenotypic characterisation of immune cells associated with histological regression in cutaneous melanoma

“…Although the lymphocytic infiltrate has been described as a favourable prognostic feature, 18 complete agreement on the role of histological regression has not been reached to date; indeed, either a negative or protective role on prognosis has been attributed to regression. [4][5][6]19 Moreover, it has been suggested that early immune activation could explain the different immunotherapy response rates in clinical practice. 20 After revision of slides and evaluation of the extent of regression, we identified a quantitative cut-off value (10%) of histological regression associated with a different outcome.…”

Multiple Lymph Node Basin Drainage in Trunk Melanoma Is Not Associated with Survival of Sentinel Lymph Node-Positive Patients

“…Melanoma is one of the most immunogenic tumours. Regression has been speculated to be a possible marker of immunogenic systemic response of this survival advantage [37] . Some authors [38,39] showed that the presence of regression in the primary tumour results from a T-cell immune response associated with a decreased risk of nodal progression.…”