免疫状态与局部 Merkel 细胞癌患者总生存的放疗疗效：国家癌症数据库分析。

Immune status and the efficacy of radiotherapy on overall survival for patients with localized Merkel cell carcinoma: An analysis of the National Cancer Database.

机构信息

Department of Radiation Oncology, University of Louisville Hospital, Louisville, Kentucky, USA.

Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky, USA.

出版信息

J Med Imaging Radiat Oncol. 2020 Jun;64(3):435-443. doi: 10.1111/1754-9485.13039. Epub 2020 May 5.

DOI:10.1111/1754-9485.13039

PMID:32372566

Abstract

BACKGROUND

Immunosuppressed (IS) patients with Merkel cell carcinoma (MCC) have worse outcomes compared to immunocompetent (IC) patients, and it is unclear if adjuvant radiotherapy (RT) is beneficial for these patients. We sought to determine the effect of immune status on adjuvant RT efficacy regarding overall survival (OS) for patients with localized MCC.

METHODS

This was an observational study of National Cancer Database (NCDB) identifying patients with stage I/II or III MCC with known immune status diagnosed from 2010 to 2014. The median follow-up time was 29 months. OS was described using Kaplan-Meier methods and compared for subgroups by immune status and adjuvant RT using log-rank tests, multivariable Cox regression and interaction effect testing.

RESULTS

A total of 2049 IC and 255 IS patients were included. Adjuvant RT was associated with decreased hazard of death for stage I/II MCC (HR 0.65, CI 0.54-0.78) adjusting for factors including immune status. Interaction effect testing did not demonstrate a significant difference in the effect of adjuvant RT on OS between IC and IS status in either stage I/II or III MCC (both P values > 0.05).

CONCLUSIONS

In this observational study, adjuvant RT was associated with decreased hazard of death for patients with stage I/II MCC regardless of immune status. Adjuvant RT should be considered for both IS and IC patients with localized MCC.

摘要

背景

与免疫功能正常（IC）患者相比，患有 Merkel 细胞癌（MCC）的免疫抑制（IS）患者的预后更差，目前尚不清楚辅助放疗（RT）是否对这些患者有益。我们旨在确定免疫状态对局部 MCC 患者的总生存（OS）的辅助 RT 疗效的影响。

方法

这是一项观察性研究，通过国家癌症数据库（NCDB）确定了 2010 年至 2014 年间诊断为 I/II 期或 III 期 MCC 且免疫状态已知的患者。中位随访时间为 29 个月。使用 Kaplan-Meier 方法描述 OS，并通过免疫状态和辅助 RT 使用对数秩检验、多变量 Cox 回归和交互作用检验进行亚组比较。

结果

共纳入 2049 例 IC 和 255 例 IS 患者。辅助 RT 与降低 I/II 期 MCC 的死亡风险相关（HR 0.65，CI 0.54-0.78），调整了包括免疫状态在内的因素。交互作用检验未显示在 I/II 期或 III 期 MCC 中，辅助 RT 对 OS 的影响在 IC 和 IS 状态之间存在显著差异（均 P 值>0.05）。