Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma
Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma
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DOI：
10.1002/cncr.26626
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发表时间：
2012-07-01
期刊：
影响因子：
6.2
通讯作者：
Coit, Daniel G.
中科院分区：
文献类型：
--
作者：
Fields, Ryan C.;Busam, Klaus J.;Coit, Daniel G.
背景：默克尔细胞癌(MCC)是一种罕见的皮肤神经内分泌肿瘤，其自然病史知之甚少。在这里，作者描述了他们对在单一机构接受治疗的大量患者的经验，以描述治疗后复发的模式。方法：对一个前瞻性数据库进行综述。记录患者相关变量、肿瘤相关变量和治疗相关变量，并记录初始复发的位置和时间。确定与接受辅助治疗和复发相关的因素。结果：总共有364例I-III期MCC患者接受了完全切除。分别有23%、23%和15%的患者选择接受局部放疗、淋巴结放疗和化疗。接受辅助治疗的相关因素包括较年轻的年龄、原发肿瘤特征(较大的肿瘤、淋巴血管侵犯[LVI]、阳性切缘切除)和病理分期增加。中位随访3.6年，108例(30%)复发，其中局部复发11例(3%)，中途复发12例(3%)，淋巴结复发43例(12%)，远处复发42例(12%)。临床受累淋巴结、原发肿瘤LVI和白血病/淋巴瘤病史是复发的预测因素。大多数复发(80%)发生在临床上有淋巴结受累的患者或没有接受病理淋巴结评估的患者。结论：对于临床淋巴结阴性的MCC患者，只要进行适当的手术(包括前哨淋巴结活检)，并对高危肿瘤选择辅助放射治疗，复发率较低。相比之下，临床淋巴结阳性的MCC患者复发率显著较高，尤其是远端复发。作者的结论是，当代自然史研究对设计MCC的治疗路径和临床试验至关重要。癌症2011年。(C)2011年美国癌症协会。
BACKGROUND: Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm whose natural history is poorly understood. Here, the authors describe their experience with a large cohort of patients who were treated at a single institution to describe patterns of recurrence after curative therapy. METHODS: Review of a prospective database was performed. Patient-related, tumor-related, and treatment-related variables were recorded, and the site and timing of initial recurrence were recorded. Factors associated with receipt of adjuvant therapy and recurrence were determined. RESULTS: In total, 364 patients with stage I through III MCC who underwent complete resection were identified. Adjuvant local radiation therapy (RT), lymph node RT, and chemotherapy were received selectively by 23%, 23%, and 15% of patients, respectively. Factors associated with the receipt of adjuvant therapy included younger age, primary tumor features (larger size, lymphovascular invasion [LVI], positive margin excision), and increasing pathologic stage. With median follow-up of 3.6 years, 108 patients (30%) developed a recurrence, including 11 local recurrences (3%), 12 in-transit recurrences (3%), 43 lymph node recurrences (12%), and 42 distant recurrences (12%). Clinically involved lymph nodes, primary tumor LVI, and a history of leukemia/lymphoma were predictive of recurrence. The majority of recurrences (80%) occurred in patients who had clinically involved lymph nodes or patients who did not undergo pathologic lymph node evaluation. CONCLUSIONS: A low recurrence rate in patients with clinically lymph node-negative MCC was achieved with adequate surgery (including sentinel lymph node biopsy) and the selective use of adjuvant RT for high-risk tumors. In contrast, patients with clinically lymph node-positive MCC had significantly higher rates of recurrence, especially distant recurrence. The authors concluded that contemporary natural history studies are critical in designing treatment pathways and clinical trials for MCC. Cancer 2011. (c) 2011 American Cancer Society.