Lai Michela, Piana Simonetta, Brancaccio Gabriella, Briatico Giulia, Mirra Marica, Raucci Margherita, Ronchi Andrea, Zerbini Alessandro, Carone Chiara, Banzi Maria, Kaleci Shaniko, Argenziano Giuseppe, Longo Caterina
Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Clin Exp Dermatol. 2025 Jun 25;50(7):1385-1394. doi: 10.1093/ced/llaf020.
Recent studies have analysed the impact of Merkel cell polyomavirus (MCPyV) on the clinical features and prognosis of patients with Merkel cell carcinoma (MCC). However, there are currently no available data on specific morphological clinical differences of MCC according to MCPyV-positive (MCPyV+) and -negative (MCPyV-) status and any possible prognostic implications of the different clinical presentations.
To describe the clinicopathological characteristics of patients with MCC and the prevalence of MCPyV infection in an Italian cohort of patients and to define possible differences in clinicopathological and prognostic features among MCPyV+ and MCPyV- MCCs.
A retrospective, multicentre cohort study was conducted in two Italian tertiary referral centres. MCPyV presence was detected by immunohistochemistry and real-time polymerase chain reaction (RT-PCR) with two different primer sets, amplifying the viral protein (VP1) or large T antigen (LT) viral regions (VP1-PCR and LT-PCR, respectively). Clinicopathological features were compared between MCPyV+ and MCPyV- tumours and between red exophytic nodules and subcutaneous cyst-like MCCs.
Of the 62 MCCs that were included, 43 (69%) presented as red exophytic nodules and 12 (19%) with a subcutaneous cyst-like appearance; MCPyV was detected in 25 cases (40%) by IHC, 35 (56%) by VP1-PCR and 49 (79%) by LT-PCR. No correlation was found between clinical morphology and viral status. Mortality rate was higher for MCPyV- cases (77%) than for MCPyV+ (23%) (P = 0.239) and higher for red nodules (70%) than for cyst-like lesions (59%) (P = 0.005). By multivariable analysis, age at diagnosis, Ki67 proliferation index and treatment with surgery/radiotherapy remained the only factors significantly affecting overall survival.
This study highlights the potential impact of clinical morphology of MCCs on prognosis. Subcutaneous cyst-like morphology may provide a survival benefit to the patients, regardless of MCPyV status.
近期研究分析了默克尔细胞多瘤病毒（MCPyV）对默克尔细胞癌（MCC）患者临床特征及预后的影响。然而，目前尚无关于MCC根据MCPyV阳性（MCPyV+）和阴性（MCPyV-）状态的具体形态学临床差异以及不同临床表现的任何可能预后意义的可用数据。
描述意大利一组MCC患者的临床病理特征及MCPyV感染率，并确定MCPyV+和MCPyV-的MCC之间在临床病理和预后特征方面的可能差异。
在意大利两个三级转诊中心进行了一项回顾性多中心队列研究。通过免疫组织化学和实时聚合酶链反应（RT-PCR），使用两组不同引物分别扩增病毒蛋白（VP1）或大T抗原（LT）病毒区域（分别为VP1-PCR和LT-PCR）来检测MCPyV的存在。比较了MCPyV+和MCPyV-肿瘤之间以及红色外生性结节和皮下囊肿样MCC之间的临床病理特征。
纳入的62例MCC中，43例（69%）表现为红色外生性结节，12例（19%）呈皮下囊肿样外观；免疫组织化学检测到25例（40%）存在MCPyV，VP1-PCR检测到35例（56%），LT-PCR检测到49例（79%）。未发现临床形态与病毒状态之间存在相关性。MCPyV-病例的死亡率（77%）高于MCPyV+病例（23%）（P = 0.239），红色结节的死亡率（70%）高于囊肿样病变（59%）（P = 0.005）。通过多变量分析，诊断时年龄、Ki67增殖指数以及手术/放疗治疗仍然是显著影响总生存期的唯一因素。
本研究强调了MCC临床形态对预后的潜在影响。皮下囊肿样形态可能为患者提供生存益处，无论MCPyV状态如何。
