早期默克尔细胞癌(MCC)的术后放射治疗(RT)可降低局部复发的风险并提高总生存率。然而,与RT指南的一致性未知.
国家癌症数据库查询了2006-2017年接受手术干预的I/II期MCC患者。根据国家综合癌症网络指南,根据具有和不具有原发肿瘤部位辅助RT指征的患者对队列进行分层。我们捕捉到了RT的使用,患者人口统计学,社会经济特征,和临床特征。Logistic回归,Kaplan-Meier方法,和倾向评分加权Cox比例风险模型检查了RT的关联和生存益处。
2,330例I/II期MCC患者接受了手术干预。1,858(79.7%)符合国家综合癌症网络标准,用于原发肿瘤部位的RT,其中1,062人(57.2%)接受RT。472(20.3%)不符合RT标准,其中203人(43.0%)接受RT。在接受RT治疗的患者中,5年的总生存优势被确定(P<0.003)。当患者接受指南不一致的RT时,没有证据显示总体生存优势(P=0.478)。
当患者符合RT标准时,对原发肿瘤部位进行辅助RT的手术切除对局部MCC具有总体生存益处。这项研究发现一组接受指南不一致RT的患者没有生存优势。有必要进行进一步的调查,以确定在治疗不足和过度的MCC治疗中指南不一致的社会人口统计学和肿瘤学原因。
Postoperative radiation therapy (RT) for early-stage Merkel Cell Carcinoma (MCC) decreases the risk of locoregional recurrence and improve overall survival. However, concordance with RT
guidelines is unknown.
The National Cancer Database was queried for stage I/II MCC patients receiving surgical intervention from 2006-2017. The cohort was stratified by patients who had and did not have indication(s) for adjuvant RT of the primary tumor site based on National Comprehensive Cancer Network
guidelines. We captured the use of RT, patient demographics, socioeconomic characteristics, and clinical characteristics. Logistic regression, Kaplan-Meier method, and propensity score weighted Cox proportional hazards model examined associations and survival benefits of RT.
2,330 stage I/II MCC patients underwent surgical intervention. 1,858 (79.7%) met National Comprehensive Cancer Network criteria for RT of the primary tumor site, of which 1,062 (57.2%) received RT. 472 (20.3%) did not meet criteria for RT, of which 203 (43.0%) received RT. Five-year overall survival advantage was identified for patients who received RT when it was indicated (P < 0.003). There was no evidence of overall survival advantage when patients received
guideline-discordant RT (P = 0.478).
Surgical resection with adjuvant RT of the primary tumor site has an overall survival benefit for local MCC when patients meet criteria for RT. This study found a group who received
guideline-discordant RT with no survival advantage. Further investigation is warranted to identify the socio-demographic and oncologic reasons for
guideline discordance in the treatment of MCC for both under- and over-treatment.