John R Sims1, Travis E Grotz2, Barbara A Pockaj3, Richard W Joseph4, Robert L Foote5, Clark C Otley6, Amy L Weaver7, James W Jakub2, Daniel L Price8. 1. Department of Otorhinolaryngology, Mayo Clinic Rochester, MN, USA. 2. Department of Surgery, Mayo Clinic Rochester, MN, USA. 3. Department of Surgery, Mayo Clinic Scottsdale, AZ, USA. 4. Department of Medical Oncology, Mayo Clinic Jacksonville, FL, USA. 5. Department of Radiation Oncology, Mayo Clinic Rochester, MN, USA. 6. Department of Dermatology, Mayo Clinic Rochester, MN, USA. 7. Department of Health Sciences Research, Mayo Clinic Rochester, MN, USA. 8. Department of Otorhinolaryngology, Mayo Clinic Rochester, MN, USA. Electronic address: price.daniel@mayo.edu.
Abstract
BACKGROUND: Merkel cell carcinoma (MCC) is a rare cutaneous malignancy of neuroendocrine origin with a high propensity for lymph node metastasis. Sentinel lymph node (SLN) status is important for accurate staging; however, the optimal treatment following SLN biopsy, regardless of nodal status, remains unclear. METHODS: 150 patients with MCC who underwent SLN biopsy from 1995 to 2011 at 3 Mayo Clinic sites were reviewed. RESULTS: Of 150 patients with MCC who underwent SLN biopsy, 39 (26%) were positive and 111 (74%) were negative. There was no significant difference between the sex, age, tumor location, or size of primary in the positive and negative SLN groups. While there was no difference in the cumulative incidence of any regional recurrence between SLN groups, the rate of in-transit recurrences was significantly higher in patients with a positive SLN (p = 0.022). The disease-specific survival for MCC was 97.0%, 82.4%, and 82.4% at 1, 3, and 5 years with a positive SLN and 99.0%, 94.9%, and 86.8% with a negative SLN (p = 0.31). Among those alive at last follow up, the median follow up was 3.8 years (IQR, 2.1-8.4) and 2.9 years (IQR, 1.8-6.1) for positive and negative SLN cohorts respectively. CONCLUSIONS: Occult nodal metastasis is common in MCC(26%). No tumor or patient characteristics were identified to predict SLN positivity. Patients with a positive SLN have a higher risk of in-transit recurrence and may benefit from adjuvant radiation with inclusion of the in-transit field in amenable cases. When patients with a positive SLN receive additional treatment to the at-risk nodal basin, both OS and DSS are similar to patients with a negative SLN.
BACKGROUND:Merkel cell carcinoma (MCC) is a rare cutaneous malignancy of neuroendocrine origin with a high propensity for lymph node metastasis. Sentinel lymph node (SLN) status is important for accurate staging; however, the optimal treatment following SLN biopsy, regardless of nodal status, remains unclear. METHODS: 150 patients with MCC who underwent SLN biopsy from 1995 to 2011 at 3 Mayo Clinic sites were reviewed. RESULTS: Of 150 patients with MCC who underwent SLN biopsy, 39 (26%) were positive and 111 (74%) were negative. There was no significant difference between the sex, age, tumor location, or size of primary in the positive and negative SLN groups. While there was no difference in the cumulative incidence of any regional recurrence between SLN groups, the rate of in-transit recurrences was significantly higher in patients with a positive SLN (p = 0.022). The disease-specific survival for MCC was 97.0%, 82.4%, and 82.4% at 1, 3, and 5 years with a positive SLN and 99.0%, 94.9%, and 86.8% with a negative SLN (p = 0.31). Among those alive at last follow up, the median follow up was 3.8 years (IQR, 2.1-8.4) and 2.9 years (IQR, 1.8-6.1) for positive and negative SLN cohorts respectively. CONCLUSIONS: Occult nodal metastasis is common in MCC(26%). No tumor or patient characteristics were identified to predict SLN positivity. Patients with a positive SLN have a higher risk of in-transit recurrence and may benefit from adjuvant radiation with inclusion of the in-transit field in amenable cases. When patients with a positive SLN receive additional treatment to the at-risk nodal basin, both OS and DSS are similar to patients with a negative SLN.
Authors: Christopher K Bichakjian; Thomas Olencki; Sumaira Z Aasi; Murad Alam; James S Andersen; Rachel Blitzblau; Glen M Bowen; Carlo M Contreras; Gregory A Daniels; Roy Decker; Jeffrey M Farma; Kris Fisher; Brian Gastman; Karthik Ghosh; Roy C Grekin; Kenneth Grossman; Alan L Ho; Karl D Lewis; Manisha Loss; Daniel D Lydiatt; Jane Messina; Kishwer S Nehal; Paul Nghiem; Igor Puzanov; Chrysalyne D Schmults; Ashok R Shaha; Valencia Thomas; Yaohui G Xu; John A Zic; Karin G Hoffmann; Anita M Engh Journal: J Natl Compr Canc Netw Date: 2018-06 Impact factor: 12.693
Authors: Yun Song; Feredun S Azari; Rebecca Tang; Adrienne B Shannon; John T Miura; Douglas L Fraker; Giorgos C Karakousis Journal: Ann Surg Oncol Date: 2020-05-13 Impact factor: 4.339
Authors: Ellen M Zwijnenburg; Satish F K Lubeek; Johanna E M Werner; Avital L Amir; Willem L J Weijs; Robert P Takes; Sjoert A H Pegge; Carla M L van Herpen; Gosse J Adema; Johannes H A M Kaanders Journal: Cancers (Basel) Date: 2021-03-31 Impact factor: 6.639
Authors: Monika Dudzisz-Sledz; Paweł Sobczuk; Katarzyna Kozak; Tomasz Switaj; Hanna Kosela-Paterczyk; Anna Malgorzata Czarnecka; Slawomir Falkowski; Paweł Rogala; Tadeusz Morysinski; Mateusz Jacek Spalek; Marcin Zdzienicki; Tomasz Goryn; Marcin Zietek; Bozena Cybulska-Stopa; Stanisław Klek; Grazyna Kaminska-Winciorek; Barbara Ziolkowska; Anna Szumera-Cieckiewicz; Piotr Rutkowski Journal: Cancers (Basel) Date: 2022-01-14 Impact factor: 6.639