Research Article

Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province, PR China

Search for more papers by this author

Jun Zhao

Department of Dermatology, The Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province, PR China

Search for more papers by this author

Bang-Zhong Zhu

Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province, PR China

Search for more papers by this author

Juan Xie

*Author for correspondence:

E-mail Address: xiejuanprs@163.com

Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province, PR China

Search for more papers by this author

Published Online:21 Apr 2020https://doi.org/10.2217/fon-2020-0064

View article

Abstract

Aim: To describe the factors affecting distant metastasis of Merkel cell carcinoma (MCC) and the prognosis of metastatic MCC. Materials & methods: The MCC patient information was downloaded from the SEER database. Logistic regression and Cox proportional hazard models were conducted to screen for significant factors. Results: A total of 3449 patients were enrolled. Surgery and chemotherapy were significantly correlated with the occurrence of distant metastasis. In the cause-specific survival rate of MCC, regional lymph node removal, sentinel lymph node biopsy, radiation and chemotherapy can significantly reduce the prognostic risk of patients with distant metastases. Conclusion: Our study screened out the factors affecting the distant metastasis and prognosis of MCC and more prospective studies are needed to verify our findings.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

References

1. Danino-Garcia M, Dominguez-Cruz JJ, Perez-Ruiz C et al. Clinical and epidemiological characteristics of Merkel cell carcinoma in a series of 38 patients. Actas Dermosifiliogr. 110(5), 360–365 (2019).
Medline CASGoogle Scholar
2. Becker JC, Stang A, Hausen AZ et al. Epidemiology, biology and therapy of Merkel cell carcinoma: conclusions from the EU project IMMOMEC. Cancer Immunol. Immunother. 67(3), 341–351 (2018).
Medline CASGoogle Scholar
3. Grandhaye M, Teixeira PG, Henrot P et al. Focus on Merkel cell carcinoma: diagnosis and staging. Skeletal Radiol. 44(6), 777–786 (2015).
MedlineGoogle Scholar
4. Schadendorf D, Lebbe C, Zur Hausen A et al. Merkel cell carcinoma: epidemiology, prognosis, therapy and unmet medical needs. Eur. J. Cancer 71(1), 53–69 (2017).
MedlineGoogle Scholar
5. Feng H, Shuda M, Chang Y et al. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 319(5866), 1096–1100 (2008).
Medline CASGoogle Scholar
6. Coggshall K, Tello TL, North JP et al. Merkel cell carcinoma: an update and review: pathogenesis, diagnosis and staging. J. Am. Acad. Dermatol. 78(3), 433–442 (2018). •• Introduces the current recommendations and recent progress of Merkel cell carcinoma.
MedlineGoogle Scholar
7. Alvarez-Arguelles ME, Melon S, Rojo S et al. Detection and quantification of Merkel cell polyomavirus. Analysis of Merkel cell carcinoma cases from 1977 to 2015. J. Med. Virol. 89(12), 2224–2229 (2017).
MedlineGoogle Scholar
8. Ramahi E, Choi J, Fuller CD et al. Merkel cell carcinoma. Am. J. Clin. Oncol. 36(3), 299–309 (2013).
Medline CASGoogle Scholar
9. Soltani AM, Allan BJ, Best MJ et al. Merkel cell carcinoma of the hand and upper extremity: current trends and outcomes. J. Plast. Reconstr. Aesthet. Surg. 67(3), e71–e77 (2014).
MedlineGoogle Scholar
10. Timmer FC, Klop WM, Relyveld GN et al. Merkel cell carcinoma of the head and neck: emphasizing the risk of undertreatment. Eur. Arch. Otorhinolaryngol. 273(5), 1243–1251 (2016).
MedlineGoogle Scholar
11. Trenkic Bozinovic M, Krasic D, Katic V et al. Comparative analysis of clinicopathological and immunohistochemical characteristics of Merkel cell carcinoma. J. BUON 19(2), 530–534 (2014).
MedlineGoogle Scholar
12. Jaeger T, Ring J andres C. Histological, immunohistological and clinical features of merkel cell carcinoma in correlation to merkel cell polyomavirus status. J. Skin Cancer 20(2), 98–111 (2012).
Google Scholar
13. Lee YW, Bae YC, Nam SB et al. Merkel cell carcinoma: a series of seven cases. Arch. Plast. Surg. 46(5), 441–448 (2019).
MedlineGoogle Scholar
14. Paulson KG, Park SY, Vandeven NA et al. Merkel cell carcinoma: current US incidence and projected increases based on changing demographics. J. Am. Acad. Dermatol. 78(3), 457–463.e452 (2018).
MedlineGoogle Scholar
15. Samimi M, Gardair C, Nicol JT et al. Merkel cell polyomavirus in merkel cell carcinoma: clinical and therapeutic perspectives. Semin. Oncol. 42(2), 347–358 (2015).
MedlineGoogle Scholar
16. Foulongne V, Dereure O, Kluger N et al. Merkel cell polyomavirus DNA detection in lesional and nonlesional skin from patients with Merkel cell carcinoma or other skin diseases. Br. J. Dermatol. 162(1), 59–63 (2010).
Medline CASGoogle Scholar
17. Shuda M, Arora R, Kwun HJ et al. Human Merkel cell polyomavirus infection I. MCV T antigen expression in Merkel cell carcinoma, lymphoid tissues and lymphoid tumors. Int. J. Cancer 125(6), 1243–1249 (2009).
Medline CASGoogle Scholar
18. Sastre-Garau X, Peter M, Avril MF et al. Merkel cell carcinoma of the skin: pathological and molecular evidence for a causative role of MCV in oncogenesis. J. Pathol. 218(1), 48–56 (2009).
Medline CASGoogle Scholar
19. Paulson KG, Carter JJ, Johnson LG et al. Antibodies to merkel cell polyomavirus T antigen oncoproteins reflect tumor burden in merkel cell carcinoma patients. Cancer Res. 70(21), 8388–8397 (2010).
Medline CASGoogle Scholar
20. Touzé A, Le Bidre E, Laude H et al. High levels of antibodies against merkel cell polyomavirus identify a subset of patients with merkel cell carcinoma with better clinical outcome. J. Clin. Oncol. 29(12), 1612–1619 (2011).
Medline CASGoogle Scholar
21. Fields RC, Busam KJ, Chou JF et al. Recurrence and survival in patients undergoing sentinel lymph node biopsy for merkel cell carcinoma: analysis of 153 patients from a single institution. Ann. Surg. Oncol. 18(9), 2529–2537 (2011).
MedlineGoogle Scholar
22. Fritsch VA, Camp ER, Lentsch EJ. Sentinel lymph node status in Merkel cell carcinoma of the head and neck: not a predictor of survival. Head Neck 36(4), 571–579 (2014).
MedlineGoogle Scholar
23. Kachare SD, Wong JH, Vohra NA et al. Sentinel lymph node biopsy is associated with improved survival in Merkel cell carcinoma. Ann. Surg. Oncol. 21(5), 1624–1630 (2014).
MedlineGoogle Scholar
24. Sadeghi R, Adinehpoor Z, Maleki M et al. Prognostic significance of sentinel lymph node mapping in Merkel cell carcinoma: systematic review and meta-analysis of prognostic studies. Biomed. Res. Int. 20(4), 489–499 (2014).
Google Scholar
25. Servy A, Maubec E, Sugier PE et al. Merkel cell carcinoma: value of sentinel lymph-node status and adjuvant radiation therapy. Ann. Oncol. 27(5), 914–919 (2016).
Medline CASGoogle Scholar
26. Sims JR, Grotz TE, Pockaj BA et al. Sentinel lymph node biopsy in Merkel cell carcinoma: the Mayo Clinic experience of 150 patients. Surg. Oncol. 27(1), 11–17 (2018). •• Evaluates the benefits of sentinel lymph node biopsy for patients with Merkel cell carcinoma and makes recommendations accordingly.
MedlineGoogle Scholar
27. Lemos BD, Storer BE, Iyer JG et al. Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system. J. Am. Acad. Dermatol. 63(5), 751–761 (2010).
MedlineGoogle Scholar
28. Ko JS, Prieto VG, Elson PJ et al. Histological pattern of Merkel cell carcinoma sentinel lymph node metastasis improves stratification of Stage III patients. Mod. Pathol. 29(2), 122–130 (2016).
Medline CASGoogle Scholar
29. Fields RC, Busam KJ, Chou JF et al. Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma. Cancer 118(13), 3311–3320 (2012).
MedlineGoogle Scholar
30. Boyer JD, Zitelli JA, Brodland DG et al. Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation. J. Am. Acad. Dermatol. 47(6), 885–892 (2002).
MedlineGoogle Scholar
31. Takagishi SR, Marx TE, Lewis C et al. Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck. Adv. Radiat. Oncol. 1(4), 244–251 (2016).
MedlineGoogle Scholar
32. Kaufman HL, Russell J, Hamid O et al. Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol. 17(10), 1374–1385 (2016). •• Introducing avelumab treatment options makes sense for advanced patients.
Medline CASGoogle Scholar
33. Saxena A, Rubens M, Ramamoorthy V et al. Risk of second cancers in merkel cell carcinoma: a meta-analysis of population based cohort studies. J. Skin Cancer 20(1), 84–95 (2014).
Google Scholar
34. Paulson KG, Iyer JG, Blom A et al. Systemic immune suppression predicts diminished Merkel cell carcinoma-specific survival independent of stage. J. Invest. Dermatol. 133(3), 642–646 (2013).
Medline CASGoogle Scholar
35. Medina-Franco H, Urist MM, Fiveash J et al. Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases. Ann. Surg. Oncol. 8(3), 204–208 (2001).
Medline CASGoogle Scholar
36. Harms PW. Update on Merkel cell carcinoma. Clin. Lab. Med. 37(3), 485–501 (2017).
MedlineGoogle Scholar
37. Tadmor T, Aviv A, Polliack A. Merkel cell carcinoma, chronic lymphocytic leukemia and other lymphoproliferative disorders: an old bond with possible new viral ties. Ann. Oncol. 22(2), 250–256 (2011).
Medline CASGoogle Scholar
38. Caramanti RL, Chaddad Neto FE, Meguins LC et al. Brain metastasis of Merkel cell carcinoma – a rare case report. Surg. Neurol. Int. 10(2), 166–172 (2019).
MedlineGoogle Scholar
39. Jacob AT, Alexandru-Abrams D, Abrams EM et al. Stereotactic radiosurgery for merkel cell carcinoma brain metastases. J. Clin. Neurosci. 22(9), 1499–1502 (2015).
MedlineGoogle Scholar

Vol. 16, No. 16

Metrics

Downloaded 189 times

History

Received 29 January 2020

Accepted 7 April 2020

Published online 21 April 2020

Published in print June 2020

Information

Keywords

Acknowledgments

We would like to thank the staff members of the National Cancer Institute and their colleagues across the USA and at Information Management Services, Inc., who have been involved with the Surveillance, Epidemiology and End Results (SEER) Program.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

This article has been permitted to obtain the data from SEER database (Reference Number 16760-Nov2018).

PDF download

Frequency and prognosis of metastasis to liver, lung, bone and brain from Merkel cell carcinoma

Abstract

References