Division of Research, Kaiser Permanente Northern California, Oakland2Department of Dermatology, University of California at San Francisco.
Division of Research, Kaiser Permanente Northern California, Oakland.
JAMA Dermatol. 2014 Jul;150(7):716-23. doi: 10.1001/jamadermatol.2013.8116.
Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine-derived skin cancer with high rates of recurrence and associated mortality. Few published studies have used comprehensive patient data and long-term follow-up to examine factors that predict MCC outcomes.
To characterize MCC in a large defined-population cohort and analyze predictors of disease recurrence and survival.
SETTING, DESIGN, AND PARTICIPANTS: Retrospective cohort study of 218 patients with MCC from the cancer registry of Kaiser Permanente Northern California, a large integrated health care delivery system. Patients were diagnosed as having MCC and followed up from January 1, 1995, through December 31, 2009. We examined host (age, sex, race, and immunosuppression), tumor (anatomic site, size, and extent), diagnostic (results of imaging and pathologic nodal evaluation), and treatment (surgery, radiation therapy, and chemotherapy) variables for their association with MCC outcomes.
Host, tumor, diagnostic, and treatment factors.
Recurrence (locoregional and distant) of MCC and patient survival (overall and MCC specific).
We estimated adjusted hazard ratios (AHRs) and 95% CIs for outcomes using Cox proportional hazards regression models. After adjustment for host, tumor, diagnostic, and treatment variables, tumor extent (categorized as local, regional, and distant) remained significantly associated with all outcomes. Immunosuppression was associated with higher MCC-specific mortality (AHR, 4.9 [95% CI, 1.7-14.4]), and an unknown primary site was associated with a lower risk for distant metastasis (0.1 [0.0-0.7]) and improved survival (0.4 [0.2-0.9]). Pathological nodal evaluation was associated with a lower risk for metastasis (AHR, 0.2 [95% CI, 0.0-1.0]) and improved survival. Radiation treatment was associated with a decreased risk for locoregional recurrence (AHR, 0.3 [95% CI, 0.1-0.6]), whereas chemotherapy was not associated with any alteration in outcomes.
Tumor site and extent, results of pathologic nodal evaluation, and the presence of radiation treatment were associated with MCC recurrence. Immunosuppression, tumor extent, and results of pathologic nodal evaluation were associated with MCC-specific survival, whereas chemotherapy was not associated with any outcomes. Our findings may help to inform diagnostic and therapeutic management of MCCs.
Merkel 细胞癌（MCC）是一种罕见的、侵袭性的、神经内分泌衍生的皮肤癌，具有高复发率和相关死亡率。很少有发表的研究使用综合的患者数据和长期随访来检查预测 MCC 结局的因素。
在大型确定人群队列中描述 MCC，并分析疾病复发和生存的预测因素。
设置、设计和参与者：回顾性队列研究纳入了 Kaiser Permanente Northern California 癌症登记处的 218 例 MCC 患者，该登记处是一个大型综合医疗服务提供系统。患者被诊断为 MCC，并于 1995 年 1 月 1 日至 2009 年 12 月 31 日进行随访。我们研究了宿主（年龄、性别、种族和免疫抑制）、肿瘤（解剖部位、大小和范围）、诊断（影像学和病理淋巴结评估结果）和治疗（手术、放疗和化疗）变量与 MCC 结局的关系。
宿主、肿瘤、诊断和治疗因素。
MCC 的复发（局部和远处）和患者生存（总体和 MCC 特异性）。
我们使用 Cox 比例风险回归模型估计了结局的调整后危险比（AHR）和 95%置信区间。在调整宿主、肿瘤、诊断和治疗变量后，肿瘤范围（分类为局部、区域和远处）仍然与所有结局显著相关。免疫抑制与 MCC 特异性死亡率增加相关（AHR，4.9 [95%CI，1.7-14.4]），而原发灶不明与远处转移风险降低相关（0.1 [0.0-0.7]）和生存改善（0.4 [0.2-0.9]）。病理淋巴结评估与转移风险降低相关（AHR，0.2 [95%CI，0.0-1.0]）和生存改善相关。放疗与局部区域复发风险降低相关（AHR，0.3 [95%CI，0.1-0.6]），而化疗与任何结局改变无关。
肿瘤部位和范围、病理淋巴结评估结果以及放疗的存在与 MCC 复发相关。免疫抑制、肿瘤范围和病理淋巴结评估结果与 MCC 特异性生存相关，而化疗与任何结局无关。我们的研究结果可能有助于为 MCC 的诊断和治疗管理提供信息。
