Hurley C M, ALNafisee D, Jones D, Kelly J L, Regan P J, Hussey A J, McInerney N
Department of Plastic & Reconstructive Surgery, University Hospital Galway, Galway, Ireland.
Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin, Ireland.
JPRAS Open. 2022 May 14;33:161-170. doi: 10.1016/j.jpra.2022.05.005. eCollection 2022 Sep.
Merkel cell carcinoma (MCC) is an aggressive malignancy of presumed neuroendocrine origin. Most case series of MCC are limited by low case numbers and are not specific to head and neck tumours. The purpose of this study was to provide a focused review of head and neck MCC diagnosis and management in a single Irish institution.
Patient's demographics, tumour characteristics, pathological diagnosis, surgical treatment, adjuvant treatment, subsequent management and clinical course were collected. Estimates of progression-free MCC survival rates were calculated by the Kaplan-Meier statistical model. A Pearson product-moment correlation coefficient examined the association between surgical margins and disease-free follow-up.
In total, 11 patients were treated for head and neck MCC with a mean age of 79.6 years (range = 69-91 years). The mean average follow-up duration of patients was 18.3 months. Of the cohort, 18% (=2) had a sentinel node biopsy (SLNB). A selective neck dissection was subsequently performed in 18% (=2). In total, 72% (=8) of patients received adjuvant radiotherapy. Median disease-specific survival was 15 months for the SLNB group and 17 months for the non-SLNB group, not statistically significant (=0.23). There was no significant association between surgical margins and disease-free follow (=0.65).
Our case series adds to a limited body of evidence of head and neck MCC. Surgery remains the treatment priority in localized disease, with an increasing role of SLNB for accurate prognostication and staging. Early management of stage I disease results in moderate long-term disease-free survivability.
默克尔细胞癌（MCC）是一种侵袭性恶性肿瘤，推测起源于神经内分泌。大多数MCC病例系列受限于病例数量少，且并非专门针对头颈部肿瘤。本研究的目的是对爱尔兰一家机构的头颈部MCC诊断和治疗进行重点综述。
收集患者的人口统计学资料、肿瘤特征、病理诊断、手术治疗、辅助治疗、后续管理和临床病程。采用Kaplan-Meier统计模型计算无进展MCC生存率估计值。采用Pearson积矩相关系数检验手术切缘与无病随访之间的关联。
共有11例患者接受了头颈部MCC治疗，平均年龄79.6岁（范围=69-91岁）。患者的平均随访时间为18.3个月。在该队列中，18%（=2）的患者进行了前哨淋巴结活检（SLNB）。随后18%（=2）的患者进行了选择性颈部清扫术。共有72%（=8）的患者接受了辅助放疗。SLNB组的疾病特异性生存中位数为15个月，非SLNB组为17个月，差异无统计学意义（=0.23）。手术切缘与无病随访之间无显著关联（=0.65）。
我们的病例系列增加了头颈部MCC的有限证据。手术仍然是局限性疾病的治疗重点，SLNB在准确预后和分期方面的作用越来越大。I期疾病的早期管理可带来中等程度的长期无病生存率。
