Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland.
Am J Clin Pathol. 2020 Jun 8;154(1):38-47. doi: 10.1093/ajcp/aqaa017.
Merkel cell carcinoma is a rare but very aggressive cutaneous tumor. We evaluated the prognostic potential of B-cell markers (terminal deoxynucleotidyl transferase [TdT], PAX5, CD117), follicular stem cell markers (CK15, CK19), p63, p53, RB, and Merkel cell polyomavirus (MCPyV; CM2B4) in 136 primary cutaneous Merkel cell carcinomas.
Clinical, histopathologic, and immunohistochemical analyses were performed. The results were correlated with patient outcomes by Fisher exact test, log-rank tests, and Cox multivariate models.
By Fisher exact test, although TdT significantly correlated with both lack of progression (P = .0087) and alive status (P = .0056), MCPyV status correlated only with alive status (P = .031). In univariate analyses, TdT, MCPyV, and RB significantly correlated with improved overall survival, whereas p63 and CK15 correlated with worse overall survival. However, in multivariate analyses, only TdT expression remained as an independent predictor of improved overall survival, Merkel cell carcinoma-specific survival, and progression-free survival. By linear regression analyses, significant correlations between MCPyV vs TdT, PAX5, and CD117 were observed.
TdT expression is a potential marker of better survival in Merkel cell carcinoma. Expression of B-cell markers is associated with MCPyV, suggesting that clonal viral integration might play a role in the expression of these markers.
默克尔细胞癌是一种罕见但侵袭性很强的皮肤肿瘤。我们评估了 B 细胞标志物（末端脱氧核苷酸转移酶 [TdT]、PAX5、CD117）、滤泡干细胞标志物（CK15、CK19）、p63、p53、RB 和 Merkel 细胞多瘤病毒（MCPyV；CM2B4）在 136 例原发性皮肤 Merkel 细胞癌中的预后潜力。
进行临床、组织病理学和免疫组织化学分析。通过 Fisher 精确检验、对数秩检验和 Cox 多变量模型将结果与患者结局进行相关性分析。
通过 Fisher 精确检验，尽管 TdT 与无进展（P =.0087）和存活状态（P =.0056）显著相关，但 MCPyV 状态仅与存活状态相关（P =.031）。在单因素分析中，TdT、MCPyV 和 RB 与总体生存率提高显著相关，而 p63 和 CK15 与总体生存率降低相关。然而，在多因素分析中，只有 TdT 表达仍然是总体生存率、Merkel 细胞癌特异性生存率和无进展生存率提高的独立预测因子。通过线性回归分析，观察到 MCPyV 与 TdT、PAX5 和 CD117 之间存在显著相关性。
TdT 表达是 Merkel 细胞癌生存更好的潜在标志物。B 细胞标志物的表达与 MCPyV 相关，提示克隆性病毒整合可能在这些标志物的表达中发挥作用。
