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Chang JWC, Chang YY, Huang YL, Lo YF, Ho TY, Huang YT, Chen HW, Yeh CN, Wu CE. Merkel cell carcinoma in Taiwan: A series of 24 cases and literature review. Medicine (Baltimore) 2019; 98:e17538. [PMID: 31626116 PMCID: PMC6824798 DOI: 10.1097/md.0000000000017538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine carcinoma of the skin. The available reports of MCC in Asia are limited; in this study, we report the largest series of MCC in Taiwan to date.The series is composed by 24 pathologically proven MCC cases, which were retrospectively reviewed in Chang Gung Memorial Hospital in Taiwan between 2000 and 2018.The tumor occurred predominantly in men (80%) and in the elderly (median 74.8 years). Twenty-one patients had locoregional MCC and 3 had metastatic MCC at the time of diagnosis. Patients with pathologically proven negative nodes by sentinel lymph node biopsy (SLNB) showed better survival time than those without SLNB in 16 clinically node-negative MCC cases undergoing primary surgery. Salvage surgery for loco-regional recurrence lengthened the survival time and possibly cured recurrent MCC. Palliative chemotherapy with cisplatin and etoposide showed a response rate of 25%, progression-free survival of 3.6 months, and overall survival of 14.8 months in 4 metastatic/recurrent MCC. Avelumab treatment was effective in 1 patient, who achieved a durable disease control.This observational cohort of MCC patients in Taiwan suggests aggressive surgical intervention including wide excision and lymph node management, salvage operation is critical for early MCC patients, and palliative chemotherapy and immunotherapy showed their efficacy for advanced MCC patients.
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Affiliation(s)
- John Wen-Cheng Chang
- Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine,
| | - Yao-Yu Chang
- Department of Dermatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine,
| | - Yen-Lin Huang
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine,
| | - Yun-Feng Lo
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine,
| | - Tsung-Ying Ho
- Department of Nuclear Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine,
| | - Yi-Ting Huang
- Department of Radiology Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine,
| | - Huan-Wu Chen
- Department of Medical Imaging & Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan (R.O.C.)
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine,
| | - Chiao-En Wu
- Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine,
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Kouzmina M, Koljonen V, Leikola J, Böhling T, Lantto E. Frequency and locations of systemic metastases in Merkel cell carcinoma by imaging. Acta Radiol Open 2017; 6:2058460117700449. [PMID: 28540062 PMCID: PMC5433554 DOI: 10.1177/2058460117700449] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/25/2017] [Indexed: 11/17/2022] Open
Abstract
Background The primary neuroendocrine skin cancer, Merkel cell carcinoma (MCC), has a well-known predilection to metastasize systemically. However, the experience of systemic metastases in MCC is mainly disseminated through case reports due to the rarity of MCC. Purpose To elucidate the frequency and locations of systemic metastasis in MCC by reviewing the imaging of patients with metastatic MCC in a national cohort. Material and Methods Patients with diagnosed metastatic MCC by imaging studies in Finland during 1999–2012 were included in this study. We reviewed their imaging studies to evaluate the most frequent sites for systemic metastasis and determined the latency between the primary tumor diagnosis and systemic metastasis. The material includes 30 MCC patients with complete imaging series and 187 examinations, of which 102 (54%) were CT images. Results The mean latency from the primary tumor diagnosis to systemic metastasis was 2.1 years and the mean latency between the radiologic diagnosis of the metastases and death was 299 days. Metastases were recorded in several organ systems in most of the cases, and at least two separate metastatic sites in 63% of the cases. Metastatic spread was noted in 60% of the cases in distant lymph nodes. Liver and lungs were the most affected solid organs. Conclusion Systemic metastasis in MCC has no predilection site, basically every organ system can be involved. Most of the systemic metastases were recorded during the first two years after the MCC diagnosis.
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Affiliation(s)
- Maria Kouzmina
- Department of Oral and Maxillofacial Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Virve Koljonen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tom Böhling
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Eila Lantto
- Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
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Harms KL, Healy MA, Nghiem P, Sober AJ, Johnson TM, Bichakjian CK, Wong SL. Analysis of Prognostic Factors from 9387 Merkel Cell Carcinoma Cases Forms the Basis for the New 8th Edition AJCC Staging System. Ann Surg Oncol 2016; 23:3564-3571. [PMID: 27198511 DOI: 10.1245/s10434-016-5266-4] [Citation(s) in RCA: 331] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The first consensus Merkel cell carcinoma (MCC) staging system was published in 2010. New information on the clinical course prompts review of MCC staging. METHODS A total of 9387 MCC cases from the National Cancer Data Base Participant User File with follow-up and staging data (1998-2012) were analyzed. Prognostic differences based on clinical and pathological staging were evaluated. Survival estimates were compared by disease extent. RESULTS Sixty-five percent of cases presented with local disease, whereas 26 and 8 % presented with nodal and distant disease. Disease extent at presentation was predictive of 5-year overall survival (OS) with estimates of 51, 35, and 14 % for local, nodal, and distant disease. Tumor burden at the regional nodal basin was predictive of 5-year OS with estimates of 40 and 27 % for clinically occult and clinically detected nodal disease. For local disease, we confirm improved prognosis when the regional nodal basin was negative by pathological compared with clinical staging. We identified 336 cases with clinically detected nodal disease and unknown primary tumor and showed improved prognosis over cases presenting with concurrent primary tumor (OS estimates of 42 vs. 27 %). CONCLUSIONS Analysis of a national dataset of MCC cases validates the predictive value of disease extent at presentation. Separation of clinical and pathological stage groups and regrouping of unknown primary tumors are supported by the analysis. The revised staging system provides more accurate prognostication and has been formally accepted by the AJCC staging committee for inclusion in the 8th edition.
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Affiliation(s)
- Kelly L Harms
- Department of Dermatology, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.
| | - Mark A Healy
- Department of Surgery, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.,Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA
| | - Paul Nghiem
- Department of Medicine/Dermatology, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.,Department of Otolaryngology, University of Michigan Health System and Medical School, Ann Arbor, MI, USA
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System and Medical School, Ann Arbor, MI, USA
| | - Sandra L Wong
- Department of Surgery, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.,Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA.,Department of Surgery, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Liu J, Larcos G, Howle J, Veness M. Lack of clinical impact of 18 F-fluorodeoxyglucose positron emission tomography with simultaneous computed tomography for stage I and II Merkel cell carcinoma with concurrent sentinel lymph node biopsy staging: A single institutional experience from Westmead Hospital, Sydney. Australas J Dermatol 2015; 58:99-105. [PMID: 26459330 DOI: 10.1111/ajd.12400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/25/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND/OBJECTIVE 18 F-fluorodeoxyglucose (FDG) positron emission tomography with simultaneous computed tomography (PET-CT) FDG PET-CT plays an important clinical role in the staging and management of Merkel cell carcinoma (MCC) although its role in stage I and II disease relative to a sentinel lymph node biopsy (SLNB) is undefined. This study aimed to compare the clinical impact of FDG PET-CT and SLNB on management in stage I and II MCC. METHODS This was a retrospective observational study. Between 2000 and 2014, 65 patients with biopsy-proven MCC (all stages) underwent a staging FDG PET-CT as part of their investigations in Westmead Hospital, Sydney. Since 2006, 26 patients have had an SLNB and of these, 16 underwent both an SLNB and FDGPET-CT. All 16 patients had a histological diagnosis consistent with MCC without clinical evidence of regional or distant metastases prior to SLNB and FDG PET-CT (stages IB and IIB). These patients were assessed with respect to MCC staging and the subsequent change of patient management post-SLNB and FDG PET-CT. RESULTS The SLNB identified occult lymph node metastases in 10 patients (63%), with FDG PET-CT positive in only one patient (6%). Of the six SLNB-negative patients, none demonstrated additional metastases on the FDG PET-CT. CONCLUSIONS In patients with stage I and II MCC, FDG PET-CT is less sensitive than an SLNB in detecting occult metastatic lymph nodes. The routine use of FDG PET-CT in these patients may not be justified.
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Affiliation(s)
- Jui Liu
- Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Sydney, New South Wales, Australia
| | - George Larcos
- Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Julie Howle
- Department of Surgical Oncology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael Veness
- Department of Radiation Oncology, Westmead Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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