Background: The role of adding chemotherapy to adjuvant radiation therapy in resectable Merkel cell carcinoma (MCC) remains controversial. Previous studies have shown conflicting results, and long-term outcome data are limited. Objectives: In this study, we aimed to evaluate the long-term survival outcomes of patients with resectable MCC treated with surgery followed by either radiation alone or combined chemoradiation. Methods: This retrospective multicenter cohort study analyzed 105 patients with resectable MCC treated between 1985 and 2023. Patients received either adjuvant radiation alone (n= 53) or chemoradiation (n= 52) following surgery. The primary endpoints were overall survival and disease-free survival. The secondary endpoints included an analysis of prognostic factors and treatment-related characteristics. The median follow-up was 12 years. Results: The 20-year overall survival rates were 53.4% for chemoradiation versus 30.7% for radiation alone (p= 0.324). Median survival in the chemoradiation groups was not reached during the follow-up period; in the radiation group, it was 8.8 years. Likewise, the twenty-year disease-free survival rates were not significantly different between the chemoradiation and radiation groups: 47% vs. 29.3%, respectively,p= 0.495. The chemoradiation group had significantly more advanced disease (88% vs. 28.3% stage III) but was younger (median 65.9 vs. 77.3 years,p= 0.002) and received higher radiation doses (median 50 Gy vs. 45 Gy,p= 0.002). After controlling for age, stage, and tumor location in a multivariable analysis, the survival differences were still not significantly different (hazard ratio (HR) = 1.36, 95% CI 0.61–3.00,p= 0.450). Conclusions: While the multivariate analysis did not indicate a survival advantage to adding chemotherapy to radiation, the comparable survival outcomes despite significantly more advanced disease in the chemoradiation group suggest a possible benefit in high-risk patients. Our results indicate the need for prospective studies with larger, stage-matched cohorts to definitively establish the role of adjuvant chemotherapy in high-risk resectable MCC.
背景：对于可切除的默克尔细胞癌（MCC），在辅助放疗基础上联合化疗的作用仍存在争议。既往研究结果不一，且长期结局数据有限。 目的：本研究旨在评估可切除MCC患者接受手术后，分别采用单纯放疗或放化疗联合治疗的长期生存结局。 方法：这项回顾性多中心队列研究分析了1985年至2023年间接受治疗的105例可切除MCC患者。患者术后接受单纯辅助放疗（n=53）或放化疗联合治疗（n=52）。主要终点为总生存期和无病生存期，次要终点包括预后因素和治疗相关特征分析。中位随访时间为12年。 结果：放化疗组与单纯放疗组的20年总生存率分别为53.4%和30.7%（p=0.324）。随访期间放化疗组中位生存期未达到，放疗组为8.8年。两组20年无病生存率亦无显著差异：放化疗组47% vs 放疗组29.3%（p=0.495）。放化疗组疾病分期更晚（III期占比88% vs 28.3%），但患者更年轻（中位年龄65.9岁 vs 77.3岁，p=0.002）且接受更高放疗剂量（中位50 Gy vs 45 Gy，p=0.002）。多变量分析控制年龄、分期和肿瘤部位后，生存差异仍无统计学意义（风险比HR=1.36，95% CI 0.61-3.00，p=0.450）。 结论：尽管多变量分析未显示放疗联合化疗能带来生存获益，但放化疗组在疾病分期显著更晚的情况下仍获得与单纯放疗组相当的生存结局，提示高危患者可能存在潜在获益。本研究结果表明，需要通过更大规模、分期匹配的前瞻性研究，以明确辅助化疗在高危可切除MCC治疗中的作用。
肿瘤(癌症)患者之家