Tai Patricia, Joseph Kurian, Prajapati Vimal H, Jones Thachuthara Aoife, Lian Jidong, Assouline Avi, Yu Edward, Veness Michael
Department of Oncology, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada.
Department of Oncology, University of Alberta, Edmonton, AB T6G 2R3, Canada.
Curr Oncol. 2025 Apr 2;32(4):211. doi: 10.3390/curroncol32040211.
(1) Background: It is controversial if Merkel cell carcinomas (MCCs) spread to lymph nodes or distant metastases (LNM/DM) first. (2) Methods: A total of 303 patients from six institutions (March 1982-February 2015) were combined with individual patient data from a PubMed search, totaling 949 patients. The primary outcome was recurrence patterns. (3) Results: (a) More patients presented with lymph node metastases (LNMs) than DMs at diagnosis: 17.9% (166 among the 929 patients with known staging) vs. 1.9% (18/929); (b) 310/929 (33.4%) developed lifetime DM, of whom 220/310 also developed LNM. The majority (133 patients) of patients were documented to have developed LNM before DM. (c) A shorter median time of 1.5 months (range: 0-47.0) from initial diagnosis to LNM, versus 8 months (range: 0-107.8) to DM, was also found. Another observation was that 2.4% (23/949) of patients with primary tumors ≤1 cm developed lifetime DM, with the smallest being 0.2 cm. (4) Conclusions: Three observations support the idea that prior LNM gives rise to subsequent DM as the main pathway of dissemination in MCC. This implies that patients with nodal metastases should be considered for adjuvant systemic therapy studies as an enriched population. Participation in clinical trials is strongly encouraged.
(1) 背景：默克尔细胞癌（MCC）是先发生淋巴结转移还是远处转移（LNM/DM）存在争议。(2) 方法：将来自六个机构的303例患者（1982年3月至2015年2月）与通过PubMed检索获得的个体患者数据合并，共计949例患者。主要结局是复发模式。(3) 结果：(a) 诊断时出现淋巴结转移（LNM）的患者多于远处转移（DM）的患者：17.9%（929例已知分期患者中的166例） vs. 1.9%（929例中的18例）；(b) 929例中有310例（33.4%）发生终生DM，其中220例同时也发生了LNM。大多数患者（133例）被记录为在发生DM之前已发生LNM。(c) 还发现从初始诊断到LNM的中位时间较短，为1.5个月（范围：0 - 47.0），而到DM的中位时间为8个月（范围：0 - 107.8）。另一项观察结果是，原发肿瘤≤1 cm的患者中有2.4%（949例中的23例）发生终生DM，最小的为0.2 cm。(4) 结论：三项观察结果支持这样一种观点，即先前的LNM导致随后的DM是MCC主要的播散途径。这意味着对于有淋巴结转移的患者，应考虑作为一个富集人群纳入辅助全身治疗研究。强烈鼓励参与临床试验。
