在国家癌症数据库中，与广泛局部切除相比，接受 Mohs 显微外科手术治疗的 I 期和 II 期 Merkel 细胞癌的患者特征和结局。

Demographics and outcomes of stage I and II Merkel cell carcinoma treated with Mohs micrographic surgery compared with wide local excision in the National Cancer Database.

机构信息

Department of Dermatology, Boston University Medical Center, Boston, Massachusetts.

Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts.

出版信息

J Am Acad Dermatol. 2018 Jul;79(1):126-134.e3. doi: 10.1016/j.jaad.2018.01.041. Epub 2018 Feb 3.

DOI:10.1016/j.jaad.2018.01.041

PMID:29408552

Abstract

BACKGROUND

The optimal surgical approach (wide local excision [WLE] vs Mohs micrographic surgery [MMS]) for treating Merkel cell carcinoma (MCC) is yet to be determined.

OBJECTIVE

To compare survival outcomes in patients with early-stage MCC treated with MMS versus with WLE.

METHODS

A retrospective review of all cases in the National Cancer Database (NCDB) of MCC of clinical stage I or II MCC treated with WLE or MMS was performed.

RESULTS

A total of 1795 cases of stage I or II MCC who underwent WLE (n = 1685) or MMS (n = 110) were identified. There was no difference in residual tumor on surgical margins between the 2 treatment groups (P = .588). On multivariate analysis, there was no difference in overall survival between the treatment modalities (adjusted hazard ratio, 1.02; 95% confidence interval, 0.72-1.45; P = .897). There was no difference in overall survival between the 2 groups on propensity score-matched analysis.

LIMITATIONS

Disease-specific survival was not reported, as these data are not available in the National Cancer Database.

CONCLUSIONS

MMS appears to be as effective as WLE in treating early-stage MCC.

摘要

背景

治疗 Merkel 细胞癌（MCC）的最佳手术方法（广泛局部切除术[WLE]与 Mohs 显微外科手术[MMS]）尚未确定。

目的

比较接受 MMS 与 WLE 治疗的早期 MCC 患者的生存结果。

方法

对国家癌症数据库（NCDB）中所有 I 期或 II 期 MCC 患者的病例进行回顾性研究，这些患者接受 WLE 或 MMS 治疗。

结果

共确定了 1795 例接受 WLE（n=1685）或 MMS（n=110）治疗的 I 期或 II 期 MCC 患者。2 种治疗组的手术切缘残留肿瘤无差异（P=0.588）。多因素分析显示，2 种治疗方法的总生存率无差异（调整后的危险比，1.02；95%置信区间，0.72-1.45；P=0.897）。倾向评分匹配分析显示，2 组的总生存率无差异。