Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Department of Plastic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Curr Oncol. 2023 Jun 30;30(7):6246-6254. doi: 10.3390/curroncol30070462.
Merkel cell carcinoma (MCC) has a tendency for lymphatic spread and locoregional recurrence, although there is little data examining the risk factors for patients with lymph node-positive extremity lesions. The purpose of the current study was to examine the outcomes and risk factors associated with nodal metastasis in extremity MCC. We retrospectively reviewed the medical record of 120 patients with extremity MCC evaluated at our institution between 1994 and 2021. The mean age of this cohort was 71 years; 33% of patients were female; and 98% were Caucasian. Seventy-eight (65%) patients presented with localized disease. Thirty-seven (31%) patients had stage III disease, and five (4%) patients had stage IV disease. Treatment of primary lesions consisted primarily of margin-negative excision and adjuvant radiotherapy. Nodal metastases were most treated with adjuvant radiation or completion lymph node dissection. Five-year disease-specific survival in our series was 88% for patients with localized disease, 89% for stage IIIa disease, 40% for stage IIIb disease and 42% for stage IV. Factors associated with worse survival included immunosuppression and macroscopic nodal disease. In conclusion, extremity MCC has a low rate of local recurrence when treated with margin-negative excision and adjuvant radiation. However, treatment of nodal metastases remains a challenge with high rates of recurrence and mortality, particularly for patients who are immunosuppressed or who have macroscopic nodal disease.
默克尔细胞癌 (MCC) 具有淋巴扩散和局部区域复发的倾向，尽管很少有数据检查淋巴结阳性肢体病变患者的危险因素。本研究的目的是检查与肢体 MCC 淋巴结转移相关的结局和危险因素。我们回顾性地审查了 1994 年至 2021 年在我们机构评估的 120 例肢体 MCC 患者的病历。该队列的平均年龄为 71 岁；33%的患者为女性；98%为白种人。78 例（65%）患者表现为局限性疾病。37 例（31%）患者为 III 期疾病，5 例（4%）患者为 IV 期疾病。原发性病变的治疗主要包括边缘阴性切除和辅助放疗。淋巴结转移主要采用辅助放疗或完全淋巴结清扫术治疗。本系列患者的 5 年疾病特异性生存率为局限性疾病患者 88%，IIIa 期疾病患者 89%，IIIb 期疾病患者 40%，IV 期疾病患者 42%。与生存较差相关的因素包括免疫抑制和宏观淋巴结疾病。总之，当边缘阴性切除和辅助放疗治疗肢体 MCC 时，局部复发率较低。然而，淋巴结转移的治疗仍然是一个挑战，复发率和死亡率较高，特别是对于免疫抑制或有宏观淋巴结疾病的患者。
