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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Effect of Sentinel Lymph Node Biopsy andLVIon Merkel Cell Carcinoma Prognosis and Treatment
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Effect of Sentinel Lymph Node Biopsy andLVIon Merkel Cell Carcinoma Prognosis and Treatment

机译：Sentinel淋巴结活检Andlvion Merkel细胞癌预后和治疗的影响

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Objective Prognostic factors and optimal treatment approaches for Merkel cell carcinoma (MCC) remain uncertain. This study evaluated the influences of sentinel lymph node (SLN) biopsy and lymphovascular invasion (LVI) on treatment planning and prognosis. Study Design Retrospective cohort study. Methods Stage 1 to 3 MCC patients treated 2005 to 2018. Predictors of nodal radiation were tested using logistic regression. Predictors of recurrence-free, disease-specific, and overall survival were tested in Cox proportional hazard models. Results Of 122 patients, 99 were without clinically apparent nodal metastases. Of these, 76 (77%) underwent excision and SLN biopsy; 29% had metastasis in SLNs, including 20% of MCCs 1 cm or less. Primary tumor diameter, site, patient age, gender, and immunosuppressed status were not significantly associated with an involved SLN. Among patients who underwent SLN biopsy, 13 of 21 (62%) MCCs with LVI had cancer in SLNs compared with 14 of 44 (25.5%) without LVI (P = .003). Although local radiation was common, nodal radiation was infrequently employed in SLN negative (pathologic N0) patients (21.8% vs. 76.2% for patients with SLN metastases,P = .0001). Survival of patients with positive SLNs was unfavorable, regardless of completion lymphadenectomy and/or adjuvant radiation. After accounting for tumor (T) and node (N) classification, age, immunosuppression, and primary site, a positive SLN and LVI were independently associated with worse survival (LVI/recurrence-free survival [RFS]: hazard ratio [HR] 2.3 (1.04-5,P = .04; LVI/disease-specific survival [DSS]: HR 5.2 (1.8-15,P = .007); N1a vs. pN0/RFS HR 3.6 (1.42-9.3,P = .007); DSS HR5.0 (1.3-19,P = .17). Conclusion SLN biopsy assists in risk stratification and radiation treatment planning in MCC. LVI and disease in SLNs, independently associated with worse survival, constitute markers of high-risk disease warranting consideration for investigational studies. Level of Evidence IIILaryngoscope, 2020
机译：目的默克尔细胞癌（MCC）的预后因素和最佳治疗方法仍不确定。本研究评估了前哨淋巴结（SLN）活检和淋巴血管侵犯（LVI）对治疗计划和预后的影响。研究设计：回顾性队列研究。方法2005年至2018年接受治疗的1至3期MCC患者。淋巴结辐射的预测因子采用logistic回归进行检验。在Cox比例风险模型中测试无复发、疾病特异性和总生存率的预测因子。结果122例患者中，99例无明显淋巴结转移。其中76例（77%）接受了切除和SLN活检；29%的患者有前哨淋巴结转移，包括20%1cm或以下的MCC。原发肿瘤直径、部位、患者年龄、性别和免疫抑制状态与SLN的发生无显著相关性。在接受前哨淋巴结活检的患者中，21例（62%）伴有LVI的MCC中有13例（25.5%）发生前哨淋巴结癌，而44例（25.5%）无LVI的MCC中有14例（P=0.003）。尽管局部放疗很常见，但SLN阴性（病理性N0）患者很少使用淋巴结放疗（SLN转移患者分别为21.8%和76.2%，P=0.0001）。无论是否完成淋巴结切除术和/或辅助放疗，前哨淋巴结阳性患者的生存率都是不利的。在考虑肿瘤（T）和淋巴结（N）分类、年龄、免疫抑制和原发部位后，SLN和LVI阳性与较差的生存率独立相关（LVI/无复发生存率[RFS]：危险比[HR]2.3（1.04-5，P=.04；LVI/疾病特异性生存率[DSS]：HR 5.2（1.8-15，P=.007）；N1a与pN0/RFS HR之比为3.6（1.42-9.3，P=0.007）；DSS HR5。0（1.3-19，P=0.17）。结论SLN活检有助于MCC的危险分层和放射治疗规划。LVI和SLN中的疾病与较差的生存率独立相关，构成高风险疾病的标志物，值得研究考虑。证据水平IIILaryngoscope，2020年

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