Shalata Walid, Edri Hanna T Frumin, Sarel Ina, Ievko Anna, Turaieva Sofiia, Tairov Tanzilya, Berezhnov Ilia, Fenig Shlomit, Fenig Eyal, Ziv-Baran Tomer, Yakobson Alexander, Brenner Ronen
The Legacy Heritage Cancer Center, Dr. Larry Norton Institute, Soroka Medical Center, Beer Sheva 84105, Israel.
Faculty of Health Sciences, BenGurion University of the Negev, Beer Sheva 84105, Israel.
Cancers (Basel). 2025 Mar 11;17(6):945. doi: 10.3390/cancers17060945.
The role of adding chemotherapy to adjuvant radiation therapy in resectable Merkel cell carcinoma (MCC) remains controversial. Previous studies have shown conflicting results, and long-term outcome data are limited.
In this study, we aimed to evaluate the long-term survival outcomes of patients with resectable MCC treated with surgery followed by either radiation alone or combined chemoradiation.
This retrospective multicenter cohort study analyzed 105 patients with resectable MCC treated between 1985 and 2023. Patients received either adjuvant radiation alone ( = 53) or chemoradiation ( = 52) following surgery. The primary endpoints were overall survival and disease-free survival. The secondary endpoints included an analysis of prognostic factors and treatment-related characteristics. The median follow-up was 12 years.
The 20-year overall survival rates were 53.4% for chemoradiation versus 30.7% for radiation alone ( = 0.324). Median survival in the chemoradiation groups was not reached during the follow-up period; in the radiation group, it was 8.8 years. Likewise, the twenty-year disease-free survival rates were not significantly different between the chemoradiation and radiation groups: 47% vs. 29.3%, respectively, = 0.495. The chemoradiation group had significantly more advanced disease (88% vs. 28.3% stage III) but was younger (median 65.9 vs. 77.3 years, = 0.002) and received higher radiation doses (median 50 Gy vs. 45 Gy, = 0.002). After controlling for age, stage, and tumor location in a multivariable analysis, the survival differences were still not significantly different (hazard ratio (HR) = 1.36, 95% CI 0.61-3.00, = 0.450).
While the multivariate analysis did not indicate a survival advantage to adding chemotherapy to radiation, the comparable survival outcomes despite significantly more advanced disease in the chemoradiation group suggest a possible benefit in high-risk patients. Our results indicate the need for prospective studies with larger, stage-matched cohorts to definitively establish the role of adjuvant chemotherapy in high-risk resectable MCC.
在可切除的默克尔细胞癌（MCC）中，辅助放疗联合化疗的作用仍存在争议。既往研究结果相互矛盾，长期预后数据有限。
在本研究中，我们旨在评估接受手术治疗后单独放疗或放化疗联合治疗的可切除MCC患者的长期生存结局。
这项回顾性多中心队列研究分析了1985年至2023年间接受治疗的105例可切除MCC患者。患者术后接受单独辅助放疗（n = 53）或放化疗（n = 52）。主要终点为总生存期和无病生存期。次要终点包括预后因素分析和治疗相关特征。中位随访时间为12年。
放化疗组的20年总生存率为53.4%，单独放疗组为30.7%（P = 0.324）。随访期间放化疗组未达到中位生存期；放疗组为8.8年。同样，放化疗组和放疗组的20年无病生存率无显著差异：分别为47%和29.3%，P = 0.495。放化疗组疾病进展更严重（III期患者占88% vs. 28.3%），但患者更年轻（中位年龄65.9岁 vs. 77.3岁，P = 0.002），接受的放疗剂量更高（中位剂量50 Gy vs. 45 Gy，P = 0.002）。在多变量分析中对年龄、分期和肿瘤位置进行校正后，生存差异仍无显著统计学意义（风险比（HR）= 1.36，95%置信区间0.61 - 3.00，P = 0.450）。
虽然多变量分析未表明放疗联合化疗具有生存优势，但放化疗组疾病进展更严重的情况下生存结局相当，提示对高危患者可能有益。我们的结果表明，需要开展前瞻性研究，纳入更大规模、分期匹配的队列，以明确辅助化疗在高危可切除MCC中的作用。
