Effect of Host, Tumor, Diagnostic, and Treatment Variables on Outcomes in a Large Cohort With Merkel Cell Carcinoma
Effect of Host, Tumor, Diagnostic, and Treatment Variables on Outcomes in a Large Cohort With Merkel Cell Carcinoma
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DOI：
10.1001/jamadermatol.2013.8116
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发表时间：
2014-07-01
期刊：
影响因子：
10.9
通讯作者：
Nghiem, Paul
中科院分区：
文献类型：
--
作者：
Asgari, Maryam M.;Sokil, Monica M.;Nghiem, Paul
默克尔细胞癌（MCC）是一种罕见的侵袭性神经内分泌源性皮肤癌，具有高复发率和相关死亡率。很少有已发表的研究使用全面的患者数据和长期随访来检查预测MCC结局的因素。目的在一个大型人群队列中研究MCC的特征，并分析疾病复发和生存的预测因素。背景、设计和参与者：来自北加州Kaiser Permanente癌症登记处的218例MCC患者的回顾性队列研究，这是一个大型综合医疗服务系统。从1995年1月1日至2009年12月31日，患者被诊断为MCC，并进行了随访。我们检查了宿主（年龄、性别、种族和免疫抑制）、肿瘤（解剖部位、大小和范围）、诊断（影像学和病理淋巴结评估结果）和治疗（手术、放疗和化疗）变量与MCC预后的关系。暴露：宿主、肿瘤、诊断和治疗因素。主要结果和指标：MCC的复发（局部和远处）和患者生存（总体和特异性MCC）。结果：我们使用Cox比例风险回归模型估计了校正风险比（AHRs）和95% ci。在调整宿主、肿瘤、诊断和治疗变量后，肿瘤范围（分为局部、区域和远处）仍然与所有结果显著相关。免疫抑制与较高的mcc特异性死亡率相关（AHR, 4.9 [95% CI, 1.7-14.4]），未知原发部位与较低的远处转移风险相关（0.1[0.0-0.7]）和改善的生存率相关（0.4[0.2-0.9]）。病理淋巴结评估与转移风险降低（AHR, 0.2 [95% CI, 0.0-1.0]）和生存率提高相关。放射治疗与局部复发风险降低相关（AHR, 0.3 [95% CI, 0.1-0.6]），而化疗与预后的任何改变无关。肿瘤部位和范围、病理淋巴结评估结果和放射治疗的存在与MCC复发相关。免疫抑制、肿瘤范围和病理淋巴结评估结果与mcc特异性生存相关，而化疗与任何结果无关。我们的发现可能有助于mcc的诊断和治疗管理。
IMPORTANCE Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine-derived skin cancer with high rates of recurrence and associated mortality. Few published studies have used comprehensive patient data and long-term follow-up to examine factors that predict MCC outcomes.OBJECTIVE To characterize MCC in a large defined-population cohort and analyze predictors of disease recurrence and survival.SETTING, DESIGN, AND PARTICIPANTS Retrospective cohort study of 218 patients with MCC from the cancer registry of Kaiser Permanente Northern California, a large integrated health care delivery system. Patients were diagnosed as having MCC and followed up from January 1, 1995, through December 31, 2009. We examined host (age, sex, race, and immunosuppression), tumor (anatomic site, size, and extent), diagnostic (results of imaging and pathologic nodal evaluation), and treatment (surgery, radiation therapy, and chemotherapy) variables for their association with MCC outcomes.EXPOSURE Host, tumor, diagnostic, and treatment factors.MAIN OUTCOMES AND MEASURES Recurrence (locoregional and distant) of MCC and patient survival (overall and MCC specific).RESULTS We estimated adjusted hazard ratios (AHRs) and 95% CIs for outcomes using Cox proportional hazards regression models. After adjustment for host, tumor, diagnostic, and treatment variables, tumor extent (categorized as local, regional, and distant) remained significantly associated with all outcomes. Immunosuppression was associated with higher MCC-specific mortality (AHR, 4.9 [95% CI, 1.7-14.4]), and an unknown primary site was associated with a lower risk for distant metastasis (0.1 [0.0-0.7]) and improved survival (0.4 [0.2-0.9]). Pathological nodal evaluation was associated with a lower risk for metastasis (AHR, 0.2 [95% CI, 0.0-1.0]) and improved survival. Radiation treatment was associated with a decreased risk for locoregional recurrence (AHR, 0.3 [95% CI, 0.1-0.6]), whereas chemotherapy was not associated with any alteration in outcomes.CONCLUSIONS AND RELEVANCE Tumor site and extent, results of pathologic nodal evaluation, and the presence of radiation treatment were associated with MCC recurrence. Immunosuppression, tumor extent, and results of pathologic nodal evaluation were associated with MCC-specific survival, whereas chemotherapy was not associated with any outcomes. Our findings may help to inform diagnostic and therapeutic management of MCCs.