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Effect of Sentinel Lymph Node Biopsy and LVI on Merkel Cell Carcinoma Prognosis and Treatment
Author(s) -
Harounian Jonathan A.,
Molin Nicole,
Galloway Thomas J.,
Ridge Drew,
Bauman Jessica,
Farma Jeffrey,
Reddy Sanjay,
Lango Miriam N.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28866
Subject(s) - medicine , merkel cell carcinoma , sentinel lymph node , biopsy , lymphovascular invasion , hazard ratio , proportional hazards model , stage (stratigraphy) , oncology , cancer , carcinoma , surgery , urology , metastasis , breast cancer , confidence interval , paleontology , biology
Objective Prognostic factors and optimal treatment approaches for Merkel cell carcinoma (MCC) remain uncertain. This study evaluated the influences of sentinel lymph node (SLN) biopsy and lymphovascular invasion (LVI) on treatment planning and prognosis. Study Design Retrospective cohort study. Methods Stage 1 to 3 MCC patients treated 2005 to 2018. Predictors of nodal radiation were tested using logistic regression. Predictors of recurrence‐free, disease‐specific, and overall survival were tested in Cox proportional hazard models. Results Of 122 patients, 99 were without clinically apparent nodal metastases. Of these, 76 (77%) underwent excision and SLN biopsy; 29% had metastasis in SLNs, including 20% of MCCs 1 cm or less. Primary tumor diameter, site, patient age, gender, and immunosuppressed status were not significantly associated with an involved SLN. Among patients who underwent SLN biopsy, 13 of 21 (62%) MCCs with LVI had cancer in SLNs compared with 14 of 44 (25.5%) without LVI ( P = .003). Although local radiation was common, nodal radiation was infrequently employed in SLN negative (pathologic N0) patients (21.8% vs. 76.2% for patients with SLN metastases, P = .0001). Survival of patients with positive SLNs was unfavorable, regardless of completion lymphadenectomy and/or adjuvant radiation. After accounting for tumor (T) and node (N) classification, age, immunosuppression, and primary site, a positive SLN and LVI were independently associated with worse survival (LVI/recurrence‐free survival [RFS]: hazard ratio [HR] 2.3 (1.04–5, P = .04; LVI/disease‐specific survival [DSS]: HR 5.2 (1.8–15, P = .007); N1a vs. pN0/RFS HR 3.6 (1.42–9.3, P = .007); DSS HR5.0 (1.3–19, P = .17). Conclusion SLN biopsy assists in risk stratification and radiation treatment planning in MCC. LVI and disease in SLNs, independently associated with worse survival, constitute markers of high‐risk disease warranting consideration for investigational studies. Level of Evidence III Laryngoscope , 131:E828–E835, 2021