Mattavelli I, Patuzzo R, Torri V, Gallino G, Maurichi A, Lamera M, Valeri B, Bolzonaro E, Barbieri C, Tolomio E, Moglia D, Nespoli A M, Galeone C, Saw R, Santinami M
Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Eur J Surg Oncol. 2017 Aug;43(8):1536-1541. doi: 10.1016/j.ejso.2017.05.013. Epub 2017 May 25.
Debate remains about prognostic factors in primary Merkel cell carcinoma (MCC). We investigated clinicopathological factors as determinants of survival in patients with MCC submitted to sentinel node biopsy.
Sixty-four consecutive patients treated for a primary MCC were identified from a prospectively maintained database at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan. Time to events outcome were described by product limit estimators and proportional hazards model was used to investigate the association between outcome and potential predictors.
The most common site of primary tumor was lower limbs (56.3%). The size of primary lesion was ≤2 cm in 67.2% of cases. Presence of residual disease after the diagnostic surgical excision was observed in 28% of cases. All patients received sentinel node biopsy (SNB) and a SN positivity was detected in 26.6%. The median follow up was 78 months. Disease recurrence occurred in 17 patients (26.6%). In the SN negative group 10 recurrences occurred (21.3%), whereas 7 (41.2%) were found in SN positive one. Nine patients SN negative (19.1%) died of disease and 3 (17.6%) among SN positive. SN status was not associated with survival (p = 0.78). Neither age, gender, size and site of primary tumor resulted predictors of patients' outcome. The presence of residual tumor in the specimen of the wide local excision, after the diagnostic surgical excision, was the only variable associated with survival (p = 0.03).
Presence of residual tumor in the specimen of the wide local excision is the main prognostic factor in MCC patients.
关于原发性默克尔细胞癌（MCC）的预后因素仍存在争议。我们研究了临床病理因素，作为接受前哨淋巴结活检的MCC患者生存的决定因素。
从米兰 Fondazione IRCCS Istituto Nazionale dei Tumori 前瞻性维护的数据库中识别出 64 例连续接受原发性 MCC 治疗的患者。事件发生时间结局采用乘积限估计法描述，并使用比例风险模型研究结局与潜在预测因素之间的关联。
原发性肿瘤最常见的部位是下肢（56.3%）。67.2%的病例原发性病变大小≤2 cm。28%的病例在诊断性手术切除后观察到残留疾病。所有患者均接受了前哨淋巴结活检（SNB），其中 26.6%检测到 SN 阳性。中位随访时间为 78 个月。17 例患者（26.6%）出现疾病复发。在 SN 阴性组中发生了 10 次复发（21.3%），而在 SN 阳性组中发现了 7 次（41.2%）。9 例 SN 阴性患者（19.1%）死于疾病，SN 阳性患者中有 3 例（17.6%）。SN 状态与生存无关（p = 0.78）。年龄、性别、原发性肿瘤的大小和部位均未成为患者结局的预测因素。诊断性手术切除后，广泛局部切除标本中残留肿瘤的存在是与生存相关的唯一变量（p = 0.03）。
广泛局部切除标本中残留肿瘤的存在是MCC患者的主要预后因素。
