Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma

Journal Article · Fri Feb 15 04:00:00 EST 2019 · Annals of Surgical Oncology (Online)

DOI:https://doi.org/10.1245/S10434-018-7072-7· OSTI ID:22927885

Lee, Jay S. ^[1]; Durham, Alison B.; Bichakjian, Christopher K. ^[2]; Harms, Paul W. ^[3]; Hayman, James A. ^[4]; McLean, Scott A. ^[5]; Harms, Kelly L. ^[2]

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1. University of Michigan, Division of Surgical Oncology, Department of Surgery, Michigan Medicine (United States)
2. University of Michigan, Department of Dermatology (United States)
3. University of Michigan, Department of Pathology (United States)
4. University of Michigan, Department of Radiation Oncology (United States)
5. University of Michigan, Department of Otolaryngology (United States)

Background: For sentinel lymph node (SLN) metastasis from Merkel cell carcinoma (MCC), the benefit of completion lymph node dissection (CLND) versus radiation therapy (RT) is unclear. This study compares outcomes for patients with SLN metastasis undergoing CLND or RT. We also evaluated positive non-SLNs as a prognostic factor. Methods: Using a prospective database, we identified MCC patients with SLN metastasis who underwent CLND or RT. At our institution, CLND was recommended for patients with acceptable perioperative risk, while therapeutic RT was offered to those with high perioperative risk. Primary outcomes were MCC-specific survival (MCCSS), disease-free survival (DFS), nodal recurrence-free survival (NRFS), and distant recurrence-free survival (DRFS). Results: From 2006 to 2017, 163 patients underwent CLND (n = 137) or RT (n = 26). Median follow-up was 1.9 years. CLND had no significant differences for MCCSS (5-year survival 71% vs. 64%, p = 1.0), DFS (52% vs. 61%, p = 0.8), NRFS (76% vs. 91%, p = 0.3), or DRFS (65% vs. 75%, p = 0.3) compared with RT. Patients with positive non-SLNs (n = 44) had significantly worse MCCSS (5-year survival 39% vs. 87%, p < 0.001), DFS (35% vs. 60%, p = 0.005), and DRFS (54% vs. 71%, p = 0.03) compared with negative non-SLNs (n = 93). Multivariate analysis showed positive non-SLNs were independently associated with MCCSS, DFS, and DRFS. Conclusions: CLND and RT may have similar outcomes for MCC patients with SLN metastasis when treatment aligns with our institutional practices. For patients undergoing CLND, positive non-SLNs is an important prognostic factor associated with poor survival and distant recurrence. This high-risk group should be considered for adjuvant systemic therapy trials.

• OSTI ID: 22927885
• Journal Information: Annals of Surgical Oncology (Online), Journal Name: Annals of Surgical Oncology (Online) Journal Issue: 2 Vol. 26; ISSN 1534-4681
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
HAZARDS
LYMPH NODES
METASTASES
PATIENTS
RADIOTHERAPY