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Patterns of distant metastases in 215 Merkel cell carcinoma patients: Implications for prognosis and surveillance.
Cancer Medicine ( IF 4 ) Pub Date : 2019-12-27 , DOI: 10.1002/cam4.2781
Christopher W Lewis 1 , Jamiluddin Qazi 1 , Daniel S Hippe 1, 2 , Kristina Lachance 1 , Hannah Thomas 1 , Maclean M Cook 1 , Ilsa Juhlin 1 , Neha Singh 1 , Zoe Thuesmunn 1 , Seesha R Takagishi 1 , Aubriana McEvoy 1 , Coley Doolittle-Amieva 1, 3 , Shailender Bhatia 3, 4 , Kelly G Paulson 3, 4 , Ryan B O'Malley 2 , Carolyn L Wang 2, 3 , Paul Nghiem 1, 3
Affiliation  

Approximately one-third of Merkel cell carcinoma (MCC) patients eventually develop distant metastatic disease. Little is known about whether the location of the primary lesion is predictive of initial distant metastatic site, or if survival likelihood differs depending on the metastatic site. Such data could inform imaging/surveillance practices and improve prognostic accuracy. Multivariate and competing-risk analyses were performed on a cohort of 215 MCC patients with distant metastases, 31% of whom had two or more initial sites of distant metastasis. At time of initial distant metastasis in the 215 patients, metastatic sites (n = 305) included non-regional lymph nodes (present in 41% of patients), skin/body wall (25%), liver (23%), bone (21%), pancreas (8%), lung (7%), and brain (5%). Among the 194 patients who presented with MCC limited to local or regional sites (stage I-III) but who ultimately developed distant metastases, distant progression occurred in 49% by 1 year and in 80% by 2 years following initial diagnosis. Primary MCC locations differed in how likely they were to metastasize to specific organs/sites (P < .001). For example, liver metastases were far more likely from a head/neck primary (43% of 58 patients) versus a lower limb primary (5% of 39 patients; P < .0001). Skin-only distant metastasis was associated with lower MCC-specific mortality as compared to metastases in multiple organs/sites (HR 2.7; P = .003), in the liver (HR 2.1; P = .05), or in distant lymph nodes (HR 2.0; P = .045). These data reflect outcomes before PD1-pathway inhibitor availability, which may positively impact survival. In conclusion, primary MCC location is associated with a pattern of distant spread, which may assist in optimizing surveillance. Because it is linked to survival, the site of initial distant metastasis should be considered when assessing prognosis.

中文翻译:

215名默克尔细胞癌患者远处转移的模式:对预后和监测的意义。

大约三分之一的默克尔细胞癌(MCC)患者最终发展为远处转移性疾病。关于原发灶的位置是否可预测初始远处转移部位或存活可能性是否取决于转移部位知之甚少。这样的数据可以为成像/监视实践提供信息并提高预后准确性。对215例远处转移的MCC患者进行了多变量和竞争风险分析,其中31%的患者有两个或多个远处转移的初始部位。在215例患者最初发生远处转移时,转移部位(n = 305)包括非区域性淋巴结转移(占41%的患者),皮肤/体壁(25%),肝脏(23%),骨骼( 21%),胰腺(8%),肺(7%)和脑(5%)。在194例出现MCC的患者中,局限在局部或区域性疾病(I-III期),但最终发展为远处转移,在初步诊断后1年内远处进展发生率为49%,2年内为80%。MCC的主要部位转移到特定器官/部位的可能性不同(P <.001)。例如,原发于头/颈部原发性肝癌(58例患者中的43%)比下肢原发性肝癌(39例中5%; P <.0001)的可能性更大。与多器官/部位(HR 2.7; P = 0.003),肝脏(HR 2.1; P = .05)或远处淋巴结转移相比,仅皮肤远处转移与较低的MCC特异性死亡率相关(HR 2.0; P = .045)。这些数据反映了PD1途径抑制剂可用性之前的结果,这可能对生存率产生积极影响。总之,MCC的主要位置与远距离传播模式有关,这可能有助于优化监视。因为它与生存有关,所以在评估预后时应考虑初始远处转移的部位。
更新日期:2019-12-29
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