背景:默克尔细胞癌(MCC)是一种罕见且高度侵袭性的皮肤癌。然而,关于早发性MCC(EOMCC)的临床病理特征以及EOMCC与晚发性MCC(LOMCC)的差异的研究有限.我们的目的是评估EOMCC的临床病理特征和癌症特异性生存率(CSS)。
方法:我们的队列研究分析了监测数据,流行病学,和2018年1月1日至2020年12月31日的最终结果(SEER)数据库。纳入了1941例诊断为原发性皮肤MCC的患者的数据。然后,我们将MCC患者分为两组:EOMCC患者(526例)和LOMCC患者(1415例)。CSS被用作主要结果。
结果:EOMCC组表现出晚期肿瘤进展的趋势,扩大的手术范围,增加淋巴结检索,强化放射治疗,更多利用全身治疗,和更好的预后。多变量分析显示,LOMCC(HR3.305[2.002-5.456],P<0.001),高级T级(HR1.430[1.139-1.797],P=0.002),高级N级(HR1.522[1.221-1.897],P<0.001),M1级(HR2.587[1.480-4.521],P<0.001),和辐射(HR0.586[0.410-0.837],P=0.003)与CSS显着相关。在这些因素中,EOMCC/LOMCC与CSS联系最紧密,表明LOMCC是CSS的独立风险因素。有趣的是,我们发现区域性EOMCC和局部或原位LOMCC的生存曲线几乎完全重叠(Plog-rank=0.620).此外,我们观察到,在MCC患者中,与单独使用TNM分期相比,TNM分期+年龄模型是更准确的CSS预测指标.
结论:我们发现与LOMCC相比,EOMCC具有明显的临床病理特征。EOMCC与更好的CSS相关联。TNM分期和年龄的组合比单独的TNM分期更准确地预测患者的预后。
BACKGROUND: Merkel cell carcinoma (MCC) is a rare and highly aggressive form of skin cancer. However, there is limited research on the clinicopathological features of early-onset MCC (EOMCC) and the differences between EOMCC and late-onset MCC (LOMCC). Our objective was to evaluate the clinicopathological features and cancer-specific survival (CSS) of EOMCC.
METHODS: Our cohort study analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2018, to December 31, 2020. Data from 1941 patients who were diagnosed with primary cutaneous MCC were included. We then divided the patients with MCC into two groups: those with EOMCC (526 patients) and those with LOMCC (1415 patients). CSS is used as the primary outcome.
RESULTS: The EOMCC group exhibited trends toward advanced tumor progression, an expanded surgical scope, increased lymph node retrieval, intensified radiotherapy, greater utilization of systemic therapy, and a better prognosis. Multivariate analysis revealed that LOMCC (HR 3.305 [2.002-5.456], P < 0.001), advanced T stage (HR 1.430 [1.139-1.797], P = 0.002), advanced N stage (HR 1.522 [1.221-1.897], P < 0.001), M1 stage (HR 2.587 [1.480-4.521], P < 0.001), and radiation (HR 0.586 [0.410-0.837], P = 0.003) were significantly associated with CSS. Among these factors, EOMCC/LOMCC was most strongly associated with CSS, indicating that LOMCC is an independent risk factor for CSS. Interestingly, we found that regional EOMCC and localized or in situ LOMCC had almost completely overlapping survival curves (Plog-rank = 0.620). Additionally, we observed that the TNM staging + age model was a more accurate predictor of CSS among MCC patients than using TNM staging alone.
CONCLUSIONS: We found that EOMCC has distinct clinicopathological features compared to LOMCC. EOMCC is associated with better CSS. The combination of TNM staging and age was more accurate for predicting patient outcomes than TNM staging alone.