放射治疗与默克尔细胞癌的预后改善相关。
Radiation Therapy is Associated with Improved Outcomes in Merkel Cell Carcinoma.
作者信息
Strom Tobin, Carr Michael, Zager Jonathan S, Naghavi Arash, Smith Franz O, Cruse C Wayne, Messina Jane L, Russell Jeffery, Rao Nikhil G, Fulp William, Kim Sungjune, Torres-Roca Javier F, Padhya Tapan A, Sondak Vernon K, Trotti Andy M, Harrison Louis B, Caudell Jimmy J
机构信息
Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
School of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
出版信息
Ann Surg Oncol. 2016 Oct;23(11):3572-3578. doi: 10.1245/s10434-016-5293-1. Epub 2016 Jun 1.
BACKGROUND
Following wide excision of Merkel cell carcinoma (MCC), postoperative radiation therapy (RT) is typically recommended. Controversy remains as to whether RT can be avoided in selected cases, such as those with negative margins. Additionally, there is evidence that RT can influence survival.
METHODS
We included 171 patients treated for non-metastatic MCC from 1994 through 2012 at a single institution. Patients without pathologic nodal evaluation (clinical N0 disease) were excluded to reflect modern treatment practice. The endpoints included local control (LC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS).
RESULTS
Median follow-up was 33 months. Treatment with RT was associated with improved 3-year LC (91.2 vs. 76.9 %, respectively; p = 0.01), LRC (79.5 vs. 59.1 %; p = 0.004), DFS (57.0 vs. 30.2 %; p < 0.001), and OS (73 vs. 66 %; p = 0.02), and was associated with improved 3-year DSS among node-positive patients (76.2 vs. 48.1 %; p = 0.035), but not node-negative patients (90.1 vs. 80.8 %; p = 0.79). On multivariate analysis, RT was associated with improved LC [hazard ratio (HR) 0.18, 95 % confidence interval (CI) 0.07-0.46; p < 0.001], LRC (HR 0.28, 95 % CI 0.14-0.56; p < 0.001), DFS (HR 0.42, 95 % CI 0.26-0.70; p = 0.001), OS (HR 0.53, 95 % CI 0.31-0.93; p = 0.03), and DSS (HR 0.42, 95 % CI 0.26-0.70; p = 0.001). Patients with negative margins had significant improvements in 3-year LC (90.1 vs. 75.4 %; p < 0.001) with RT. Deaths not attributable to MCC were relatively evenly distributed between the RT and no RT groups (28.5 and 29.3 % of patients, respectively).
CONCLUSIONS
RT for MCC was associated with improved LRC and survival. RT appeared to be beneficial regardless of margin status.
背景
默克尔细胞癌（MCC）广泛切除术后，通常建议进行术后放射治疗（RT）。对于某些特定情况，如切缘阴性的病例，是否可以避免放疗仍存在争议。此外，有证据表明放疗会影响生存率。
方法
我们纳入了1994年至2012年在单一机构接受非转移性MCC治疗的171例患者。排除未进行病理淋巴结评估的患者（临床N0期疾病），以反映现代治疗实践。观察终点包括局部控制（LC）、区域控制（LRC）、无病生存期（DFS）、总生存期（OS）和疾病特异性生存期（DSS）。
结果
中位随访时间为33个月。放疗与3年LC改善相关（分别为91.2%和76.9%；p = 0.01），LRC改善（79.5%对59.1%；p = 0.004），DFS改善（57.0%对30.2%；p < 0.001），OS改善（73%对66%；p = 0.02），并且在淋巴结阳性患者中与3年DSS改善相关（76.2%对48.1%；p = 0.035），但在淋巴结阴性患者中无相关性（90.1%对80.8%；p = 0.79）。多因素分析显示，放疗与LC改善相关[风险比（HR）0.18，95%置信区间（CI）0.07 - 0.46；p < 0.001]，LRC改善（HR 0.28，95%CI 0.14 - 0.56；p < 0.001），DFS改善（HR 0.42，95%CI 0.26 - 0.70；p = 0.001），OS改善（HR 0.53，95%CI 0.31 - 0.93；p = 0.03），DSS改善（HR 0.42，95%CI 0.26 - 0.70；p = 0.001）。切缘阴性的患者接受放疗后3年LC有显著改善（90.1%对75.4%；p < 0.001）。非MCC导致的死亡在放疗组和未放疗组中分布相对均匀（分别占患者的28.5%和29.3%）。
结论
MCC放疗与LRC改善和生存率提高相关。无论切缘状态如何，放疗似乎都是有益的。
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