Prognostic Factors in Merkel Cell Carcinoma:A Retrospective Single-Center Study in 90 Patients

Merkel Cell Carcinoma (MCC) is a rare but highly aggressive neuroendocrine neoplasm of the skin. This study aimed at describing characteristics, treatment, and prognosis of a series of consecutive cases of MCC patients, in order to contribute to the investigation of this rare malignancy and provide better patient care. This is a retrospective cohort study including all 90 patients diagnosed and/or treated for MCC between 1991 and 2018 at the Veneto Institute of Oncology in Padua (Italy). Patient and tumor characteristics, treatment, and immunohistochemical data were extracted from a prospectively collected local database. There were 68 primary (76%) and 22 non-primary (15 occult primary, three metastatic, four recurrence) tumors (24%). CK20 expression was associated with reduced overall (HR 2.92, 95% CI 1.04⁻8.16) and disease-specific (HR 4.62, 95% CI 1.31⁻16.28) survival. Immunomodulatory regimens for treatment of other comorbidities were associated with reduced disease-specific ((HR 2.15, 95% CI 1.06⁻4.36) and recurrence-free (HR 3.08, 95% CI 1.44⁻6.57) survival. Iatrogenic immunomodulation resulted as the main factor associated with impaired prognosis. Lack of CK20 expression was associated with better survival

默克尔细胞癌（Merkel Cell Carcinoma, MCC）是一种罕见但恶性程度极高的皮肤神经内分泌肿瘤。本研究旨在描述一系列连续性默克尔细胞癌患者的临床特征、治疗方案及预后情况，以期为该罕见恶性肿瘤的相关研究提供参考，并为优化患者诊疗护理提供依据。本研究为回顾性队列研究，纳入了1991年至2018年间于意大利帕多瓦威尼托肿瘤研究所接受诊断和/或治疗的全部90例默克尔细胞癌患者。研究人员从前瞻性收集的本地数据库中提取了患者与肿瘤特征、治疗方案及免疫组化相关数据。本队列中包含原发性肿瘤68例（占比76%），非原发性肿瘤22例（其中隐匿性原发灶15例、转移性肿瘤3例、复发性肿瘤4例，占比24%）。分析结果显示，CK20表达与较差的总生存期（风险比HR=2.92，95%置信区间CI：1.04~8.16）和疾病特异性生存期（HR=4.62，95%CI：1.31~16.28）显著相关。用于治疗其他合并症的免疫调节方案，与较差的疾病特异性生存期（HR=2.15，95%CI：1.06~4.36）及无复发生存期（HR=3.08，95%CI：1.44~6.57）相关。医源性免疫调节被证实为与预后不良相关的主要危险因素。而CK20表达缺失则与更佳的生存期显著相关。