Carcinoma de células de Merkel

Recurrence and mortality rates with different treatment approaches of Merkel cell carcinoma: a systematic review and meta-analysis

BACKGROUND

Comprehensive treatment recommendations for Merkel cell carcinoma are complex. We aimed to systematically review the published data on recurrence and mortality rates associated with various treatment approaches for Merkel cell carcinoma.

METHODS

Search of MEDLINE, Embase, Web of Science, and Scopus from inception to August 2015. Studies were included that reported comparative survival and recurrence data for two or more treatment modalities. Two reviewers independently reviewed and abstracted recurrence and mortality rates. Event rates for individual treatment arms in each study were pooled and meta-analyzed across studies using a random-effects model.

RESULTS

Fifty-two retrospective studies met inclusion criteria, revealing a total of 1,804 patients with primary Merkel cell carcinoma with data available for analyses. The recurrence rate was higher for surgery alone (55.0%) versus a combination of surgery and radiotherapy (39.0%) (odds ratio, 2.089; 95% CI, 1.374-3.177; P < 0.001). Combination therapy including surgery, radiotherapy, and chemotherapy had a higher mortality rate (44.6%) than did combined surgery and radiotherapy (23.2%) (odds ratio, 2.688; 95% CI, 1.196-6.037; P = 0.02).

CONCLUSIONS

The treatment of Merkel cell carcinoma with surgery plus adjuvant radiotherapy may produce lower recurrence rates.

[Merkel cell carcinoma in a patient with chronic lymphocytic leukemia]

Merkel cell carcinoma (MCC) is an infrequent neuroendocrine tumor of the skin with a high potential for local recurrence, lymphatic dissemination and distant dissemination. We present a case of MCC in a male patient with chronic lymphocytic leukemia (CLL). The immunosuppression induced by the leukemia or by the chemotherapy could play a pathogenic role in the association of these diseases. Positron emission tomography (PET) was a useful staging technique in this patient, and made the differential diagnosis of the lymph node involvement from MMC and CLL possible.