Sexton Kevin W, Poteet Stephen P, Hill John Bradford, Schmidt Alexandra, Patel Ashit, Del Corral Gabriel A, Axt Jason, Kelley Mark C, Thayer Wesley P, Shack Robert Bruce
From *Division of General Surgery, †Department of Plastic Surgery, ‡School of Medicine, Vanderbilt University Medical Center, Nashville, TN; §Division of Plastic Surgery, Albany Medical College, Albany, NY; and ∥Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, TN.
Ann Plast Surg. 2014 Nov;73(5):531-4. doi: 10.1097/SAP.0b013e31827f4c58.
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignancy. Adjuvant radiation increases survival in advanced stages, but efficacy in stage I disease is unknown. A retrospective review included all patients treated for stage I MCC during a 15-year period at Vanderbilt University Medical Center. Among 42 patients, 26 (62%) had a negative sentinel lymph node biopsy (stage IA) and 16 (38%) had clinically negative lymph nodes (stage IB) at the time of resection. Analysis using Cox regression revealed that higher stage and absence of adjuvant radiation are associated with increased disease recurrence (hazard ratio, 6.29; P=0.003 and hazard ratio, 4.69; P=0.013, respectively). Controlling for stage, radiation therapy significantly increased disease-free survival among patients with stage IB disease (P=0.0026) in a log-rank test comparing Kaplan-Meier curves. These findings support adjuvant radiation therapy in stage IB MCC patients with clinically negative lymph nodes who do not undergo sentinel lymph node biopsy.
默克尔细胞癌（MCC）是一种罕见且侵袭性强的皮肤恶性肿瘤。辅助放疗可提高晚期患者的生存率，但对I期疾病的疗效尚不清楚。一项回顾性研究纳入了范德比尔特大学医学中心15年间所有接受I期MCC治疗的患者。42例患者中，26例（62%）前哨淋巴结活检阴性（IA期），16例（38%）在切除时临床淋巴结阴性（IB期）。使用Cox回归分析显示，分期较高和未接受辅助放疗与疾病复发增加相关（风险比分别为6.29；P = 0.003和风险比为4.69；P = 0.013）。在比较Kaplan-Meier曲线的对数秩检验中，在控制分期的情况下，放疗显著提高了IB期疾病患者的无病生存率（P = 0.0026）。这些发现支持对未进行前哨淋巴结活检且临床淋巴结阴性的IB期MCC患者进行辅助放疗。
