Rastrelli Marco, Del Fiore Paolo, Russo Irene, Tartaglia Jacopo, Dal Monico Alessandro, Cappellesso Rocco, Nicolè Lorenzo, Piccin Luisa, Fabozzi Alessio, Biffoli Bernardo, Di Prata Claudia, Ferrazzi Beatrice, Dall'Olmo Luigi, Vecchiato Antonella, Spina Romina, Russano Francesco, Bezzon Elisabetta, Cingarlini Sara, Mazzarotto Renzo, Parisi Alessandro, Scarzello Giovanni, Pigozzo Jacopo, Brambullo Tito, Tropea Saveria, Vindigni Vincenzo, Bassetto Franco, Bertin Daniele, Gregianin Michele, Dei Tos Angelo Paolo, Cavallin Francesco, Alaibac Mauro, Chiarion-Sileni Vanna, Mocellin Simone
Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.
Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy.
Front Oncol. 2021 Dec 17;11:737842. doi: 10.3389/fonc.2021.737842. eCollection 2021.
Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. The incidence of the disease has undergone a significant increase in recent years, which is caused by an increase in the average age of the population and in the use of immunosuppressive therapies. MCC is an aggressive pathology, which metastasizes early to the lymph nodes. These characteristics impose an accurate diagnostic analysis of the regional lymph node district with radiography, clinical examination and sentinel node biopsy. In recent years, there has been a breakthrough in the treatment of the advanced pathology thanks to the introduction of monoclonal antibodies acting on the PD-1/PD-L1 axis. This study aimed to describe the clinico-pathological characteristics, treatment strategies and prognostic factors of MCC.
A retrospective cohort study was conducted involving 143 consecutive patients who were diagnosed and/or treated for MCC. These patients were referred to the Veneto Institute of Oncology IOV-IRCCS and to the University Hospital of Padua (a third-level center) in the period between December 1991 and January 2020. In the majority of cases, diagnosis took place at the IOV. However, some patients were diagnosed elsewhere and subsequently referred to the IOV for a review of the diagnosis or to begin specific therapeutic regimens.
143 patients, with an average age of 71 years, were affected mainly with autoimmune and neoplastic comorbidities. Our analysis has shown that age, autoimmune comorbidities and the use of therapy with immunomodulating drugs (which include corticosteroids, statins and beta-blockers) are associated with a negative prognosis. In this sense, male sex is also a negative prognostic factor.
Autoimmune and neoplastic comorbidities were frequent in the studied population. The use of drugs with immunomodulatory effects was also found to be a common feature of the population under examination. The use of this type of medication is considered a negative prognostic factor. The relevance of a multidisciplinary approach to the patient with MCC is confirmed, with the aim of assessing the risks and benefits related to the use of immunomodulating therapy in the individual patient.
默克尔细胞癌（MCC）是一种罕见的皮肤神经内分泌肿瘤。近年来，该疾病的发病率显著上升，这是由人口平均年龄的增加和免疫抑制疗法的使用增加所致。MCC是一种侵袭性病理类型，早期会转移至淋巴结。这些特征使得通过影像学检查、临床检查和前哨淋巴结活检对区域淋巴结区进行准确的诊断分析成为必要。近年来，由于作用于PD-1/PD-L1轴的单克隆抗体的引入，晚期病理类型的治疗取得了突破。本研究旨在描述MCC的临床病理特征、治疗策略和预后因素。
进行了一项回顾性队列研究，纳入了143例连续诊断和/或治疗MCC的患者。这些患者在1991年12月至2020年1月期间被转诊至威尼托肿瘤研究所IOV-IRCCS和帕多瓦大学医院（三级中心）。在大多数情况下，诊断在IOV进行。然而，一些患者在其他地方被诊断，随后转诊至IOV进行诊断复查或开始特定的治疗方案。
143例患者，平均年龄71岁，主要患有自身免疫性和肿瘤性合并症。我们的分析表明，年龄、自身免疫性合并症以及使用免疫调节药物（包括皮质类固醇、他汀类药物和β受体阻滞剂）治疗与不良预后相关。从这个意义上讲，男性也是一个不良预后因素。
在所研究的人群中，自身免疫性和肿瘤性合并症很常见。使用具有免疫调节作用的药物也是受检人群的一个共同特征。使用这类药物被认为是一个不良预后因素。证实了对MCC患者采用多学科方法的相关性，目的是评估个体患者使用免疫调节治疗的风险和益处。
