Front Oncol:Merkel细胞癌(MCC)的临床病理特点、治疗策略及影响预后的因素

2021-12-31 yd2015 MedSci原创

该研究发现MCC患者中自身免疫和肿瘤合并症很常见,使用免疫调节作用药物也比较常见。

Merkel细胞癌(MCC)是一种罕见的皮肤神经内分泌肿瘤。近年来,由于人口平均年龄的增加和免疫抑制治疗的使用,这一疾病的发病率显著增加。MCC早期容易转移到淋巴结。近期,来自意大利的团队开展了回顾性研究,探讨MCC的临床病理特点、治疗策略及影响预后的因素。相关结果发表在Frontiers in Oncology杂志上。

该研究回顾性纳入143例患者,男性74人,女性69人。确诊时的中位年龄为71岁。大多数患者为原发肿瘤(110例,77%)。27%为I期,15%为II期,48%为III期(最常见),10%为IV期。肢体是最常见的病变部位(57%),其次是头颈部(23%)和躯干/臀部(20%)。对99例(占总数的69.23%)患者的活检组织进行了免疫组化分析。最常见的免疫组化标记物是细胞角蛋白20(75%)、突触素(83%)、NSE(26%)、嗜铬粒蛋白(69%)、AE1/AE3(17%)、MNF 116(32%)和CAM 5.2(33%)。男性患者的无病生存期更短。24%的患者有肿瘤合并症,27%的患者有自身免疫性合并症(最常见的是1型糖尿病、类风湿或银屑病关节炎)。6%的患者患有血液肿瘤(主要是非霍奇金淋巴瘤、慢性淋巴细胞白血病、骨髓增生或骨髓增生异常综合征)。许多患者使用免疫调节药物(59例,41%),23例(16%)使用他汀类药物。最常用的免疫调节药物是皮质类固醇(16例,11%)和β-受体阻滞剂(23例,16%)。

广泛切除(WE)是原发病灶最常见的治疗方法(101例,71%)。其中52例患者也接受了前哨淋巴结活检(SNB)治疗。2例患者行前哨淋巴结直接活检,17例清扫原发灶引流区域(CLND)。15例患者接受了其他治疗(如广泛切除和肢体局部灌注),8例患者在其他中心治疗,无法检索他们的手术细节。54名患者接受了放疗(其中35名患者接受了放疗,目的是辅助治疗),50名患者接受了化疗。其中,17例患者PD-1/PD-L1抑制剂治疗(avelumab或pembrolizumab)。

128例I-III期患者的中位随访时间为31个月(IQR 15-62)。37名患者死于该病,19名患者死于其他原因。I、II和III期患者的5年总生存率(OS)分别为62、59和50% (p = 0.21)。I、II和III期患者的5年疾病特异性生存率为69、74和58% (p = 0.31)。

                OS和疾病特异性生存期

单因素分析发现,不良OS与年龄增大(HR=1.03, 95% CI 1.00-1.06)和较高的Charlson共病指数(HR=1.16, 95% CI 1.01-1.33)有关。不良疾病特异性生存期与自身免疫疾病存在(HR=2.00, 95% CI 1.03-3.91)和免疫调节药物的使用(HR=2.94, 95% CI 1.52-5.67)有关。SNB阳性患者的OS(HR 4.44, 95% CI 1.15-17.16;p = 0.03)和疾病特异性生存期(HR 3.96, 95% CI 1.00-15.72;p = 0.04)较差。与CLND≤2个阳性淋巴结患者相比,CLND≥3阳性淋巴结患者的总生存率(HR=1.77, 95% CI 0.68-4.61;p = 0.24)或疾病特异性生存率(HR=3.09, 95% CI 0.97-9.88;P = 0.06)无明显统计学差异。

              OS和疾病特异性生存期单因素分析

在数据分析时,102例I-III期原发性疾病患者中有43例复发(43%)。局部复发11例,淋巴结转移15例,远处转移13例。5年无复发生存率为43%。

            无复发生存期

不良无复发生存期与接受免疫调节药物(HR=2.51, 95% CI 1.36-4.57;p = 0.003)和放疗(HR=2.74, 95% CI 1.50-5.03;p = 0.001)应用有关。在原发灶广泛切除同时接受SNB治疗的I-III期患者中,无复发生存期与SNB阳性无关(HR=1.00, 95% CI 0.38-2.65;p = 0.99)。与CLND≤2个阳性淋巴结患者相比,CLND≥3阳性淋巴结患者的无复发生存期无明显统计学差异(HR=2.05, 95% CI 0.85-4.94;p = 0.11)。

              无复发生存的单因素分析

 

综上,该研究发现MCC患者中自身免疫和肿瘤合并症很常见,使用免疫调节作用药物也比较常见。

 

原始出处:

Rastrelli M, Del Fiore P, Russo I, et al (2021) Merkel Cell Carcinoma: Evaluation of the Clinico-Pathological Characteristics, Treatment Strategies and Prognostic Factors in a Monocentric Retrospective Series (n=143). Front. Oncol. 11:737842. doi: 10.3389/fonc.2021.737842

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    2022-11-21 minlingfeng
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    2022-11-29 chenlianhui
  5. [GetPortalCommentsPageByObjectIdResponse(id=1979267, encodeId=710f19e9267a2, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Thu Oct 13 15:49:51 CST 2022, time=2022-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1797495, encodeId=65e51e97495f7, content=<a href='/topic/show?id=96eb22906b9' target=_blank style='color:#2F92EE;'>#临床病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22906, encryptionId=96eb22906b9, topicName=临床病理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Sat Mar 12 05:49:51 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866444, encodeId=2d1c186644434, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Mon Nov 21 19:49:51 CST 2022, time=2022-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1752142, encodeId=68401e52142bb, content=<a href='/topic/show?id=735669505d' target=_blank style='color:#2F92EE;'>#ERK#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6950, encryptionId=735669505d, topicName=ERK)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5e8a36466835, createdName=chenlianhui, createdTime=Tue Nov 29 02:49:51 CST 2022, time=2022-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179454, encodeId=d95311e9454a1, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Fri Dec 31 23:39:59 CST 2021, time=2021-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179288, encodeId=928a11e9288cf, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f8991940501, createdName=1e0edfdfm63(暂无匿称), createdTime=Fri Dec 31 14:29:49 CST 2021, time=2021-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179248, encodeId=80a811e924817, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7fa45686220, createdName=ms7000001993166068, createdTime=Fri Dec 31 12:49:19 CST 2021, time=2021-12-31, status=1, ipAttribution=)]
    2021-12-31 JZ Yang

    感谢分享

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1979267, encodeId=710f19e9267a2, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Thu Oct 13 15:49:51 CST 2022, time=2022-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1797495, encodeId=65e51e97495f7, content=<a href='/topic/show?id=96eb22906b9' target=_blank style='color:#2F92EE;'>#临床病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22906, encryptionId=96eb22906b9, topicName=临床病理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Sat Mar 12 05:49:51 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866444, encodeId=2d1c186644434, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Mon Nov 21 19:49:51 CST 2022, time=2022-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1752142, encodeId=68401e52142bb, content=<a href='/topic/show?id=735669505d' target=_blank style='color:#2F92EE;'>#ERK#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6950, encryptionId=735669505d, topicName=ERK)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5e8a36466835, createdName=chenlianhui, createdTime=Tue Nov 29 02:49:51 CST 2022, time=2022-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179454, encodeId=d95311e9454a1, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Fri Dec 31 23:39:59 CST 2021, time=2021-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179288, encodeId=928a11e9288cf, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f8991940501, createdName=1e0edfdfm63(暂无匿称), createdTime=Fri Dec 31 14:29:49 CST 2021, time=2021-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179248, encodeId=80a811e924817, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7fa45686220, createdName=ms7000001993166068, createdTime=Fri Dec 31 12:49:19 CST 2021, time=2021-12-31, status=1, ipAttribution=)]
    2021-12-31 1e0edfdfm63(暂无匿称)

    有意思

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1979267, encodeId=710f19e9267a2, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Thu Oct 13 15:49:51 CST 2022, time=2022-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1797495, encodeId=65e51e97495f7, content=<a href='/topic/show?id=96eb22906b9' target=_blank style='color:#2F92EE;'>#临床病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22906, encryptionId=96eb22906b9, topicName=临床病理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Sat Mar 12 05:49:51 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866444, encodeId=2d1c186644434, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Mon Nov 21 19:49:51 CST 2022, time=2022-11-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1752142, encodeId=68401e52142bb, content=<a href='/topic/show?id=735669505d' target=_blank style='color:#2F92EE;'>#ERK#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6950, encryptionId=735669505d, topicName=ERK)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5e8a36466835, createdName=chenlianhui, createdTime=Tue Nov 29 02:49:51 CST 2022, time=2022-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179454, encodeId=d95311e9454a1, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Fri Dec 31 23:39:59 CST 2021, time=2021-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179288, encodeId=928a11e9288cf, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f8991940501, createdName=1e0edfdfm63(暂无匿称), createdTime=Fri Dec 31 14:29:49 CST 2021, time=2021-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1179248, encodeId=80a811e924817, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7fa45686220, createdName=ms7000001993166068, createdTime=Fri Dec 31 12:49:19 CST 2021, time=2021-12-31, status=1, ipAttribution=)]
    2021-12-31 ms7000001993166068

    不错

    0