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

Publication ,  Journal Article
Lee, JS; Durham, AB; Bichakjian, CK; Harms, PW; Hayman, JA; McLean, SA; Harms, KL; Burns, WR
Published in: Ann Surg Oncol
February 2019

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.

Duke Scholars

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

February 2019

Volume

26

Issue

2

Start / End Page

386 / 394

Location

United States

Related Subject Headings

  • Survival Rate
  • Skin Neoplasms
  • Sentinel Lymph Node Biopsy
  • Sentinel Lymph Node
  • Radiotherapy
  • Prospective Studies
  • Prognosis
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Neoplasm Micrometastasis
 

Citation

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Lee, J. S., Durham, A. B., Bichakjian, C. K., Harms, P. W., Hayman, J. A., McLean, S. A., … Burns, W. R. (2019). Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma. Ann Surg Oncol, 26(2), 386–394. https://doi.org/10.1245/s10434-018-7072-7
Lee, Jay S., Alison B. Durham, Christopher K. Bichakjian, Paul W. Harms, James A. Hayman, Scott A. McLean, Kelly L. Harms, and William R. Burns. “Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma.Ann Surg Oncol 26, no. 2 (February 2019): 386–94. https://doi.org/10.1245/s10434-018-7072-7.
Lee JS, Durham AB, Bichakjian CK, Harms PW, Hayman JA, McLean SA, et al. Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma. Ann Surg Oncol. 2019 Feb;26(2):386–94.
Lee, Jay S., et al. “Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma.Ann Surg Oncol, vol. 26, no. 2, Feb. 2019, pp. 386–94. Pubmed, doi:10.1245/s10434-018-7072-7.
Lee JS, Durham AB, Bichakjian CK, Harms PW, Hayman JA, McLean SA, Harms KL, Burns WR. Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma. Ann Surg Oncol. 2019 Feb;26(2):386–394.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

February 2019

Volume

26

Issue

2

Start / End Page

386 / 394

Location

United States

Related Subject Headings

  • Survival Rate
  • Skin Neoplasms
  • Sentinel Lymph Node Biopsy
  • Sentinel Lymph Node
  • Radiotherapy
  • Prospective Studies
  • Prognosis
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Neoplasm Micrometastasis