Head and Neck Cancer Service, Westmead Hospital, Sydney, Australia.
J Am Acad Dermatol. 2012 Jul;67(1):33-40. doi: 10.1016/j.jaad.2011.07.029. Epub 2011 Oct 11.
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy. Nodal status has prognostic significance.
We sought to analyze for factors predictive of survival and explore the significance of lymph node status and indication for sentinel lymph node biopsy in patients with MCC.
A review was undertaken of 136 patients presenting with MCC at our institution between 1980 and 2008. Patient and tumor characteristics, treatment, and patterns of relapse were analyzed.
Ninety patients presented with stage I disease, and 46 presented with stage II disease. The median follow-up time was 21 months. In all, 74 patients developed relapse with the commonest site of relapse in the regional lymph nodes. A total of 24 patients developed nodal relapse without prior treatment of the nodal basin. The 5-year survival was 62% and the median disease-free interval was 16 months. Radiotherapy was associated with a better disease-free survival (P < .001) and overall survival was worse as the number of involved lymph nodes increased (P = .03).
This was a retrospective review with a prolonged accrual time.
A high rate of nodal relapse occurred in patients with stage I disease who had undergone treatment of the primary site only. These patients may have benefited from sentinel lymph node biopsy and subsequent treatment of the nodal basin if micrometastatic disease was present, as the number of involved nodes impacted negatively on survival. Conversely, sentinel lymph node biopsy may be used to select those patients with clinical stage I disease who may avoid elective nodal treatment. Radiotherapy should have a routine role in the management of MCC.
默克尔细胞癌（MCC）是一种罕见的侵袭性皮肤恶性肿瘤。淋巴结状态具有预后意义。
我们旨在分析预测生存的因素，并探讨 MCC 患者的淋巴结状态和前哨淋巴结活检指征的意义。
回顾性分析了 1980 年至 2008 年在我院就诊的 136 例 MCC 患者。分析了患者和肿瘤特征、治疗和复发模式。
90 例患者表现为 I 期疾病，46 例患者表现为 II 期疾病。中位随访时间为 21 个月。共有 74 例患者复发，最常见的复发部位是区域淋巴结。共有 24 例患者在未治疗淋巴结区域的情况下发生了淋巴结复发。5 年生存率为 62%，中位无疾病间隔为 16 个月。放疗与更好的无病生存率相关（P <.001），随着淋巴结受累数目的增加，总生存率更差（P =.03）。
这是一项回顾性研究，累积时间较长。
仅治疗原发灶的 I 期患者发生淋巴结转移的比例较高。如果存在微转移疾病，这些患者可能受益于前哨淋巴结活检和随后的淋巴结治疗，因为受累淋巴结的数量对生存有负面影响。相反，前哨淋巴结活检可用于选择那些可能避免选择性淋巴结治疗的临床 I 期疾病患者。放疗应在 MCC 的治疗中常规应用。
