目的/目标(S)默克尔细胞癌(MCC)是一种罕见的,侵袭性皮肤癌传统上采用手术切除后放疗(RT)治疗。随着最近检查点抑制剂的批准,化疗不太常用。我们使用监测分析了RT和化疗对MCC患者总生存期(OS)的影响,流行病学,和最终结果(SEER),人口级数据库。材料和方法我们对MCC的SEER18自订数据注册(ICD-0-38247)进行了回顾性分析。查询了1980年至2016年的数据进行分析,和9,792例患者的初始列表被填充(ICD:C00,C07.9,C44,C80.9).选择有化疗和RT状态的病例,单原发肿瘤,原发肿瘤部位及手术治疗类型5,002例进行分析。采用卡方检验或Mann-WhitneyU检验比较基线特征。使用Kaplan-Meier和Cox比例风险回归模型进行单变量和多变量分析。使用具有治疗加权逆概率(IPTW)的倾向评分匹配分析来解释适应症偏倚。结果中位随访时间为178个月(68~217个月)。独立预后因素与OS升高呈正相关,对于未调整的多变量分析和IPTW调整的MVA均为年龄,男性,诊断年份,舞台,RT状态,和化疗状态。在调整后的MVA上,使用化疗与OS恶化相关(风险比:1.22[95%CI1.1-1.35],p<0.001),而RT与OS改善相关(HR:0.9[95%CI,0.83-0.97],p=0.008)。结论目前的研究表明,RT与MCC患者生存率的提高有关。化疗与OS恶化有关。这支持了最近的临床转变,将免疫检查点抑制剂作为转移背景下的护理标准。以及在佐剂和高级设置中的有希望的试验。
Purpose/objective(s) Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neoplasm traditionally managed with surgical resection followed by radiotherapy (RT). With the recent approval of checkpoint inhibitors, chemotherapy is less commonly utilized. We analyzed the impact of RT and chemotherapy on overall survival (OS) in patients with MCC using Surveillance, Epidemiology, and End Results (SEER), a population-level database. Materials and methods We performed retrospective analyses on SEER 18 Custom Data registries for MCC (ICD-0-3 8247). Data from 1980 to 2016 was queried for analysis, and an initial list of 9,792 patients was populated (ICD: C00, C07.9, C44, C80.9). Selection for cases with chemotherapy and RT status, single primary tumor, primary tumor location and surgery treatment type yielded 5,002 cases for analysis. Baseline characteristics were compared with Chi-square or Mann-Whitney U test. Univariate and multivariable analysis using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment weighting (IPTW) was used to account for indication bias. Results Median follow-up time was 178 months (68 to 217 months). Independent prognostic factors positively correlated with increased OS, for both unadjusted Multivariate analysis and IPTW adjusted MVA were age, male sex, year of diagnosis, stage, RT status, and chemotherapy status. On adjusted MVA, use of chemotherapy was associated with worse OS (hazard ratio: 1.22 [95% CI 1.1-1.35], p<0.001), whereas RT was associated with improved OS (HR:0.9 [95% CI, 0.83-0.97], p=0.008). Conclusions The current study demonstrates that RT is associated with improved survival for patients with MCC. Chemotherapy was associated with worse OS. This supports the recent clinical shift towards immune checkpoints inhibitors as standard of care in the metastatic setting, and promising trials in the adjuvant and advanced settings.