University of Arizona, Tucson, Arizona.
University of Arizona, Tucson, Arizona.
J Am Acad Dermatol. 2018 Oct;79(4):680-688. doi: 10.1016/j.jaad.2018.03.019. Epub 2018 Mar 21.
The stage of disease at initial diagnosis and the use of radiation therapy (RT) are important determinants of survival in patients with Merkel cell carcinoma (MCC).
To define factors that are associated with advanced-stage MCC at the time of initial diagnosis and the use of RT.
Cross-sectional, retrospective analysis of patients with MCC registered in the National Cancer Database during the period from 2004 to 2013.
A total of 11,917 patients were identified; 3152 and 4586 patients were excluded from the staging and RT analyses, respectively, because of lack of available data. African American ethnicity (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.06-2.10; P = .023), lack of medical insurance (OR, 2.15; 95% CI, 1.40-3.30; P < .001), Charlson-Deyo comorbidity score of at least 1 (OR, 1.21; 95% CI, 1.09-1.34; P < .001), residence more than 26 miles from a treatment facility (OR, 1.18; 95% CI, 1.03-1.35; P = .015), tumor located on the lower limb/hip (OR, 1.59; 95% CI, 1.42-1.78; P < .001) or trunk (OR, 2.05; 95% CI, 1.81-2.33; P < .001), and poorly (OR, 2.57; 95% CI, 1.13-5.82; P = .024) or undifferentiated (OR, 3.11; 95% CI, 1.36-7.15; P = .007) tumor histology predicted advanced-stage MCC at the time of initial diagnosis. The use of RT was associated with Native American ethnicity (OR, 5.04; 95% CI, 1.10-22.99; P = .037), tumor size between 1.5 and 2.7 cm (OR, 1.27; 95% CI, 1.10-1.47; P = .001), electing not to have surgery (OR, 2.77; 95% CI, 1.90-4.03; P < .001), positive postsurgical margins (OR, 1.39; 95% CI, 1.18-1.63; P < .001), and receiving treatment at a comprehensive cancer program (OR, 1.25; 95% CI, 1.03-1.50; P = .020).
Retrospective design limits generalizability of the results, and precise details of RT regimens utilized were not available.
A number of factors are associated with advanced-stage MCC at initial diagnosis and the use of RT. Health care models should account for these factors, and efforts should be directed toward improving those that are modifiable.
在 Merkel 细胞癌（MCC）患者中，初始诊断时的疾病分期和放射治疗（RT）的使用是生存的重要决定因素。
确定与初始诊断时晚期 MCC 以及 RT 使用相关的因素。
对 2004 年至 2013 年期间国家癌症数据库中登记的 MCC 患者进行横断面、回顾性分析。
共确定了 11917 例患者；由于缺乏可用数据，分别有 3152 例和 4586 例患者被排除在分期和 RT 分析之外。非裔美国人种族（比值比[OR]，1.49；95%置信区间[CI]，1.06-2.10；P=0.023）、缺乏医疗保险（OR，2.15；95%CI，1.40-3.30；P<0.001）、Charlson-Deyo 合并症评分至少为 1 分（OR，1.21；95%CI，1.09-1.34；P<0.001）、居住地距离治疗机构超过 26 英里（OR，1.18；95%CI，1.03-1.35；P=0.015）、肿瘤位于下肢/臀部（OR，1.59；95%CI，1.42-1.78；P<0.001）或躯干（OR，2.05；95%CI，1.81-2.33；P<0.001）、肿瘤组织学分级为低分化（OR，2.57；95%CI，1.13-5.82；P=0.024）或未分化（OR，3.11；95%CI，1.36-7.15；P=0.007），这些因素与初始诊断时的晚期 MCC 相关。RT 的使用与美洲原住民种族（OR，5.04；95%CI，1.10-22.99；P=0.037）、肿瘤大小为 1.5 至 2.7cm（OR，1.27；95%CI，1.10-1.47；P=0.001）、选择不进行手术（OR，2.77；95%CI，1.90-4.03；P<0.001）、手术切缘阳性（OR，1.39；95%CI，1.18-1.63；P<0.001）以及在综合性癌症计划中接受治疗（OR，1.25；95%CI，1.03-1.50；P=0.020）相关。
回顾性设计限制了结果的普遍性，并且无法获得确切的 RT 方案细节。
许多因素与初始诊断时的晚期 MCC 和 RT 使用相关。医疗保健模式应考虑到这些因素，并应努力改善那些可改变的因素。
