Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2012 Aug;19(8):2556-62. doi: 10.1245/s10434-011-2161-x. Epub 2012 Mar 28.
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine malignancy with an ill-defined natural history following locoregional recurrence.
This is a retrospective review of patients with MCC diagnosed at the Mayo Clinic from 1981 to 2008. For each outcome (subsequent locoregional recurrence, distant recurrence, and death) the survival-free of the outcome was estimated using the Kaplan-Meier method. Associations of patient and clinical characteristics with the outcomes were assessed by fitting Cox proportional hazards regression models.
Among the 240 patients diagnosed with MCC, 70 (29%) patients were identified who developed locoregional recurrence as the first site of recurrence. The median time from diagnosis to locoregional recurrence was 6 months. The pattern of first locoregional failure in this group includes 25 (10.4%) local, 18 (7.5%) in-transit, and 27 (11.3%) nodal recurrences. Recurrences were most commonly treated by surgery and radiation. At 3 years after the initial recurrence, locoregional recurrence-free survival was 75% and the distant recurrence-free survival was 56%. Locoregional recurrence is a poor prognostic sign associated with a 3-year overall survival of 39%. Nodal status at time of original surgery and time to first recurrence were important predictors of distant recurrence (P < 0.006) and overall survival following locoregional recurrence (P < 0.001).
Locoregional recurrence is a substantial problem in patients with MCC and is a poor prognostic sign. In those patients who experience a locoregional recurrence, aggressive efforts to regain locoregional control appear warranted and may result in long-term survival.
默克尔细胞癌（Merkel 细胞癌）是一种侵袭性皮肤神经内分泌恶性肿瘤，局部区域复发后其自然病程尚不明确。
这是对 1981 年至 2008 年在 Mayo 诊所诊断为 Merkel 细胞癌的患者进行的回顾性研究。对于每个结局（随后的局部区域复发、远处复发和死亡），使用 Kaplan-Meier 方法估计生存无结局的情况。通过拟合 Cox 比例风险回归模型评估患者和临床特征与结局的相关性。
在 240 例诊断为 Merkel 细胞癌的患者中，有 70 例（29%）患者首先发生局部区域复发。从诊断到局部区域复发的中位时间为 6 个月。该组中首次局部区域失败的模式包括 25 例（10.4%）局部复发、18 例（7.5%）转移复发和 27 例（11.3%）淋巴结复发。复发最常通过手术和放疗治疗。初次复发后 3 年，局部区域无复发生存率为 75%，远处无复发生存率为 56%。局部区域复发是预后不良的标志，与 3 年总生存率为 39%相关。原始手术时的淋巴结状态和首次复发时间是远处复发（P < 0.006）和局部区域复发后总生存（P < 0.001）的重要预测因素。
局部区域复发是 Merkel 细胞癌患者的一个重大问题，是预后不良的标志。对于经历局部区域复发的患者，积极努力争取局部区域控制是合理的，可能会导致长期生存。
