Shafique Neha, Ertmann Emily, Tortorello Gabriella N, Sharon Cimarron E, Karakousis Giorgos C, Miura John T
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Surg Oncol. 2025 May;131(6):1053-1058. doi: 10.1002/jso.28037. Epub 2024 Dec 15.
Merkel cell carcinoma (MCC) is a radiosensitive aggressive skin cancer that spreads via the lymphatics. There is uncertainty regarding the optimal management of the nodal basin for patients with MCC with clinically positive nodes. We study the efficacy of single node excision (SNE) as an alternative to a therapeutic lymph node dissection (TLND) in patients with limited nodal disease.
We performed a retrospective cohort study of patients with MCC with clinical nodal disease who underwent resection in the form of either SNE or TLND using the National Cancer Database. The association between type of surgery and overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazards modeling.
1835 patients met all inclusion criteria with 281 patients undergoing SNE and the remainder undergoing TLND. Patients receiving SNE and TLND were equally likely to receive radiation to the nodal basin (SNE 44.5% vs. TLND 48.5%, p = 0.22). There was no difference in 5-year OS between patients who received SNE versus TLND (SNE 43.9% vs. TLND 44.7%, p = 0.36). This persisted in a multivariable Cox proportional hazards model in which receipt of SNE remained not significantly associated with survival after adjusting for clinical and treatment factors including receipt of radiation (Hazard Ratio [HR] 1.17, 95% CI 0.96-1.42, p = 0.11). In patients undergoing SNE with radiation, 5-year OS was 54.4% (95% CI 44.1-63.6).
TLND is not associated with a survival advantage over SNE. Further prospective study into patterns of recurrence and safety of SNE is needed.
默克尔细胞癌（MCC）是一种通过淋巴管扩散的对放疗敏感的侵袭性皮肤癌。对于临床淋巴结阳性的MCC患者，其淋巴结区域的最佳治疗方案尚不确定。我们研究了单节点切除（SNE）作为局限性淋巴结疾病患者治疗性淋巴结清扫（TLND）替代方案的疗效。
我们使用国家癌症数据库对接受SNE或TLND手术切除的临床淋巴结疾病MCC患者进行了一项回顾性队列研究。采用Kaplan-Meier方法和Cox比例风险模型评估手术类型与总生存期（OS）之间的关联。
1835例患者符合所有纳入标准，其中281例接受SNE，其余接受TLND。接受SNE和TLND的患者接受淋巴结区域放疗的可能性相同（SNE为44.5%，TLND为48.5%，p = 0.22）。接受SNE与TLND的患者5年总生存率无差异（SNE为43.9%，TLND为44.7%，p = 0.36）。在多变量Cox比例风险模型中，这一结果仍然存在，在调整包括放疗在内的临床和治疗因素后，接受SNE与生存率仍无显著关联（风险比[HR] 1.17，95%置信区间0.96 - 1.42，p = 0.11）。在接受放疗的SNE患者中，5年总生存率为54.4%（95%置信区间44.1 - 63.6）。
TLND与SNE相比并无生存优势。需要对SNE的复发模式和安全性进行进一步的前瞻性研究。
