Journal of the American Academy of Dermatology · 2019
Sentinel lymph node biopsy in Merkel cell carcinoma: Predictors of sentinel lymph node positivity and association with overall survival.
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Conic Rosalynn R Z, Ko Jennifer, Saridakis Stephanie, Damiani Giovanni, Funchain Pauline, Vidimos Allison, Gastman Brian R
Аннотация
BACKGROUND: Merkel cell carcinoma (MCC) is a rare, aggressive malignancy with high rates of recurrence and metastasis.
OBJECTIVE: To evaluate predictors of sentinel lymph node (SLN) positivity in MCC using the National Cancer Database.
METHODS: The National Cancer Database, from 2012 to 2014, was used to identify 3048 patients with MCC, of whom 1174 received an SLN biopsy. Predictors of SLN positivity were evaluated using logistic regression. Overall survival was evaluated using a Cox proportional hazards model.
RESULTS: Of patients who underwent SLN biopsy, those with primary lesions on the trunk (odds ratio, 1.98; 95% confidence interval [CI], 1.23-3.17; P = .004), tumor-infiltrating lymphocytes (odds ratio, 1.58; 95% CI, 1.01-2.46; P = .04), or lymphovascular invasion (odds ratio, 3.45; 95% CI, 2.51-4.76; P < .001) were more likely to have positive SLNs on multivariate analysis. Overall survival was negatively affected by age ≥75 years (hazard ratio [HR], 2.55; 95% CI, 1.36-4.77; P = .003), male sex (HR, 1.78; 95% CI, 1.09-2.91, P = .022), immunosuppression (HR, 3.51; 95% CI, 1.72-7.13; P = .001), and SLN positivity (HR, 3.15; 95% CI, 1.98-5.04; P < .001).
LIMITATIONS: Lack of disease-specific survival and potential selection bias from a retrospective data set.
CONCLUSIONS: Truncal MCC, tumor-infiltrating lymphocytes, and presence of lymphovascular invasion were independent predictors of positive SLNs. Overall survival was negatively affected by advancing age, male sex, immunosuppression, and SLN positivity.
OBJECTIVE: To evaluate predictors of sentinel lymph node (SLN) positivity in MCC using the National Cancer Database.
METHODS: The National Cancer Database, from 2012 to 2014, was used to identify 3048 patients with MCC, of whom 1174 received an SLN biopsy. Predictors of SLN positivity were evaluated using logistic regression. Overall survival was evaluated using a Cox proportional hazards model.
RESULTS: Of patients who underwent SLN biopsy, those with primary lesions on the trunk (odds ratio, 1.98; 95% confidence interval [CI], 1.23-3.17; P = .004), tumor-infiltrating lymphocytes (odds ratio, 1.58; 95% CI, 1.01-2.46; P = .04), or lymphovascular invasion (odds ratio, 3.45; 95% CI, 2.51-4.76; P < .001) were more likely to have positive SLNs on multivariate analysis. Overall survival was negatively affected by age ≥75 years (hazard ratio [HR], 2.55; 95% CI, 1.36-4.77; P = .003), male sex (HR, 1.78; 95% CI, 1.09-2.91, P = .022), immunosuppression (HR, 3.51; 95% CI, 1.72-7.13; P = .001), and SLN positivity (HR, 3.15; 95% CI, 1.98-5.04; P < .001).
LIMITATIONS: Lack of disease-specific survival and potential selection bias from a retrospective data set.
CONCLUSIONS: Truncal MCC, tumor-infiltrating lymphocytes, and presence of lymphovascular invasion were independent predictors of positive SLNs. Overall survival was negatively affected by advancing age, male sex, immunosuppression, and SLN positivity.
Предметные рубрики MeSH
Age FactorsAgedBlood VesselsCarcinoma, Merkel CellDatabases, FactualFemaleHumansImmunocompromised HostLymphatic MetastasisLymphocytes, Tumor-InfiltratingMaleMiddle AgedNeoplasm InvasivenessProportional Hazards ModelsRetrospective StudiesRisk FactorsSentinel Lymph NodeSentinel Lymph Node BiopsySex FactorsSkin NeoplasmsSurvival Rate