College of Medicine, Medical University of South Carolina, Charleston, South Carolina 29425-5500, USA.
Otolaryngol Head Neck Surg. 2012 Mar;146(3):403-8. doi: 10.1177/0194599811431789. Epub 2011 Dec 13.
Explore the relationship between tumor location and prognosis among patients with Merkel cell carcinoma (MCC) of the head and neck.
Retrospective analysis of large population database.
Surveillance Epidemiology and End Results (SEER) database/multiple settings.
Using the SEER database, the authors identified patients with MCC of the head and neck. They compared clinicopathologic characteristics and disease-specific survival (DSS) between patients with head and neck MCC at different anatomic subsites. DSS was estimated by the Kaplan-Meier method, and a multivariable regression model was constructed so that independent predictors of DSS could be determined.
Of the 2104 patients identified, 61.0% were men. The mean age at diagnosis was 77.5 years. Tumors were most commonly located on the face (61.1%). Scalp tumors were significantly larger (10.4% >5 cm, P = .0001) and more likely to present with distant metastasis (8.7%, P = .07) than other head and neck tumors. Lip tumors had the highest rate of invasion into bone, cartilage, and muscle (13.7%, P = .012), and ear tumors had the highest rate of nodal metastasis (63.2%, P = .011). Patients with scalp/neck and lip primary sites had significantly worse survival on univariable analysis (P = .0054 and P = .0007, respectively); however, the lip was the only site associated with worse survival on multivariable analysis (hazard ratio = 1.8, P = .005).
This study is the first to report lip location as an independent prognostic factor in head and neck MCC. More aggressive treatment of patients with MCC of the lip may be warranted to improve outcomes.
探讨头颈部 Merkel 细胞癌（MCC）患者肿瘤位置与预后的关系。
大人群数据库的回顾性分析。
监测、流行病学和最终结果（SEER）数据库/多种设置。
作者使用 SEER 数据库，确定了头颈部 MCC 患者。他们比较了不同解剖部位头颈部 MCC 患者的临床病理特征和疾病特异性生存（DSS）。通过 Kaplan-Meier 法估计 DSS，并构建多变量回归模型，以确定 DSS 的独立预测因素。
在 2104 例患者中，61.0%为男性。诊断时的平均年龄为 77.5 岁。肿瘤最常见于面部（61.1%）。头皮肿瘤明显较大（10.4%＞5cm，P=0.0001），且更易发生远处转移（8.7%，P=0.07）。唇部肿瘤侵犯骨骼、软骨和肌肉的比例最高（13.7%，P=0.012），耳部肿瘤淋巴结转移比例最高（63.2%，P=0.011）。单变量分析显示，头皮/颈部和唇部原发部位的患者生存明显较差（P=0.0054 和 P=0.0007）；然而，多变量分析显示，唇部是唯一与生存较差相关的部位（风险比=1.8，P=0.005）。
本研究首次报道唇部位置是头颈部 MCC 的独立预后因素。可能需要对唇部 MCC 患者进行更积极的治疗，以改善预后。
