Kachare Swapnil D, Wong Jan H, Vohra Nasreen A, Zervos Emmanuel E, Fitzgerald Timothy L
Department of Surgery, Division of Surgical Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Ann Surg Oncol. 2014 May;21(5):1624-30. doi: 10.1245/s10434-013-3434-3. Epub 2013 Dec 31.
Although sentinel lymph node biopsy (SNB) has become a standard for Merkel cell carcinoma (MCC), the impact on survival is unclear. To better define the staging and therapeutic value of SNB, we compared SNB with nodal observation.
Patients with clinical stage I and II MCC in the Surveillance, Epidemiology, and End Results (SEER) registry undergoing surgery between 2003 and 2009 were identified and divided into two groups-SNB and observation.
A total of 1,193 patients met the inclusion criteria (SNB 474 and Observation 719). The median age was 78 years, and the majority were White (95.3 %), male (58.8 %), received radiation therapy (52.9 %) and had T1 tumors (65.3 %). Twenty-four percent had a positive SNB. SNB patients were younger (73 vs. 81 years; p < 0.0001), had T1 tumors (69.6 vs. 62.5 %; p = 0.04) and received radiotherapy (57.8 vs. 40 %; p < 0.0001). Among biopsy patients, a negative SNB was associated with improved 5-year MCC-specific survival (84.5 vs. 64.6 %; p < 0.0001). Univariate analysis demonstrated an increased 5-year MCC-specific survival for the SNB group versus the Observation group (79.2 vs. 73.8 %; p = 0.004), female gender (83.2 vs. 70.4 %; p = 0.0004), and lower T stage (p < 0.0001). On Cox regression, diminished survival was noted for the Observation group (risk ratio [RR] 1.43; p = 0.04), male gender (RR 2.06; p < 0.0001), and a higher T stage.
SNB for MCC provides prognostic information and is associated with a significant survival advantage.
尽管前哨淋巴结活检（SNB）已成为默克尔细胞癌（MCC）的标准治疗方法，但其对生存率的影响尚不清楚。为了更好地确定SNB的分期和治疗价值，我们将SNB与淋巴结观察进行了比较。
在监测、流行病学和最终结果（SEER）登记处中，确定2003年至2009年间接受手术的临床I期和II期MCC患者，并将其分为两组——SNB组和观察组。
共有1193例患者符合纳入标准（SNB组474例，观察组719例）。中位年龄为78岁，大多数为白人（95.3%），男性（58.8%），接受放射治疗（52.9%），且为T1期肿瘤（65.3%）。24%的患者前哨淋巴结活检结果为阳性。SNB组患者更年轻（73岁对81岁；p<0.0001），为T1期肿瘤（69.6%对62.5%；p=0.04），且接受放射治疗（57.8%对40%；p<0.0001）。在活检患者中，前哨淋巴结活检结果为阴性与5年MCC特异性生存率提高相关（84.5%对64.6%；p<0.0001）。单因素分析显示，SNB组的5年MCC特异性生存率高于观察组（79.2%对73.8%；p=0.004），女性（83.2%对70.4%；p=0.0004），以及较低的T分期（p<0.0001）。在Cox回归分析中，观察组生存率降低（风险比[RR]1.43；p=0.04），男性（RR 2.06；p<0.0001），以及较高的T分期。
MCC的前哨淋巴结活检可提供预后信息，并具有显著的生存优势。
