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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Presentation 4 - Head and Neck Surgery

CD8+ Tumor-Infiltrating Lymphocytes as Independent Biomarkers in Head and Neck Mucosal Melanoma

Sunday, October 12, 2025
1:30 PM - 1:36 PM EDT
Location: 127
Disclosure(s):
Nicholas K. Fung, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Eric W. Wang, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Head and neck mucosal melanoma (HNMM) is a distinct clinical entity compared to cutaneous melanoma with worse response rates to immune checkpoint inhibitor therapy. CD8+ tumor infiltrating lymphocytes (TIL) density have been shown to be a promising biomarker for prognostication in other cancer types, including metastatic cutaneous melanoma. In this study, we explored the prognostic role of TIL density in HNMM.

Methods: Forty-five patients with primary HNMM treated between January 2002 and December 2021 at the University of Pittsburgh were included. For patients with ample primary tumor specimens, CD8+ TIL density was quantified using an automated image analysis algorithm on digitized slides. ROC curves were used to delineate a biomarker cutoff. Survival analysis using the Kaplan Meier method and cox proportional hazards were performed with recurrence-free survival (RFS) and overall survival (OS) as primary and secondary endpoints respectively.

Results: Thirty-four patients had ample tissue from primary tumor resection specimens available for analysis. A CD8+ TIL density threshold of 373.6 cells/mm2 best delineated patients based on survival outcomes. On log-rank testing, TIL high patients trended toward improved 5-year RFS (p=0.06) and OS (p=0.074) when compared to TIL low patients. Using multivariate analysis, high TIL density was significantly associated with improved RFS (HR (95% CI): 0.17 (0.03–0.83), p=0.028) but not improved OS (HR (95% CI): 0.48 (0.08–2.90), p=0.4). Tumor characteristics such as advanced nodal staging (HR (95% CI): 13.2 (1.68–104), p=0.014), and presence of metastatic disease (HR (95% CI): 48.2 (1.94–1196), p=0.018) were associated with worsened RFS.

Conclusions: Automated, digital CD8+ TIL density enumeration is a reliable method of assessing TIL density in HNMM patients. High CD8+ TIL density is an independent factor associated with improved RFS and trended towards improved OS.

    Presenting Author(s)

  • NF

    Nicholas K. Fung, MD

    Clinical Fellow in Rhinology
    Department of Otolaryngology, Emory University
    Atlanta, GA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • DH

    Douglas Hartman, MD

    Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States

    Disclosure information not submitted.

  • DD

    Diwakar Davar, MD

    Division of Hematology-Oncology, Department of Medicine, UPMC Hillman Cancer Center, Pittsburgh, PA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • EW

    Eric W. Wang, MD

    Professor of Otolaryngology, Neurological Surgery and Ophthalmology
    University of Pittsburgh School of Medicine
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.