Narrow resection margins are not associated with mortality or recurrence in patients with Merkel cell carcinoma: A retrospective study

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:84

Article

Jaouen, Frederic^1,2,15  Kervarrec, Thibault^1,3,4  Caille, Agnes^1,5,13  Le Corre, Yannick^6,15  Dreno, Brigitte^7,15  Esteve, Eric^8,15  Wierzbicka-Hainaut, Ewa^9,15  Maillard, Herve^10,15  Dinulescu, Monica^11,15  Blom, Astrid¹²  Saiag, Philippe^12,14  Samimi, Mahtab^1,2,4,15 

[1] Univ Tours, Tours, France

[2] Tours Univ Hosp, Dermatol Dept, Tours, France

[3] Tours Univ Hosp, Pathol Dept, Tours, France

[4] Univ Tours, Biol Infect Polyomavirus, ISP 1282 INRA, Tours, France

[5] Univ Nantes, Univ Tours, Sphere U1246, INSERM, Nantes, France

[6] Angers Univ Hosp, Dermatol Dept, Angers, France

[7] Nantes Univ Hosp, Dermatol Dept, Nantes, France

[8] Orleans Reg Hosp, Dermatol Dept, Orleans, France

[9] Univ Poitiers Hosp, Dermatol Dept, Poitiers, France

[10] Le Mans Reg Hosp, Dermatol Dept, Le Mans, France

[11] Rennes Univ Hosp, Dermatol Dept, Rennes, France

[12] Ambroise Pare Hosp, Dermatol Dept, Boulogne, France

[13] Tours Univ Hosp, INSERM Ctr Invest Clin 1415, Tours, France

[14] Univ Paris Saclay, Univ Versailles St Quentin En Yvelines, Versailles, France

[15] Inst Dermatol Grand Ouest IDGO, Nantes, France

关键词: general surgery;    Merkel cell carcinoma;    mortality;    neoplasms;    prognosis;    skin surgical margins;    wide local excision;   

DOI  :  10.1016/j.jaad.2020.11.038

来源: Elsevier

【 摘 要 】

Background: Wide local excision constitutes the standard of care for Merkel cell carcinoma, but the optimal margin width remains controversial. Objectives: To assess whether narrow margins (0.5-1 cm) were associated with outcome. Methods: Patients were recruited from a retrospective French multicentric cohort and included if they had had excision of primary tumor with minimum lateral margins of 0.5 cm. Factors associated with mortality and recurrence were assessed by multivariate regression. Results: Among the 214 patients included, 58 (27.1%) had undergone excision with narrow margins (0.5-1 cm) versus 156 (72.9%) with wide margins (>1 cm). During a median follow-up of 50.7 months, cancer-specific survival did not differ between groups (5-year specific survival rate 76.8% [95% confidence interval 61.7%-91.9%] and 76.2% [95% confidence interval 68.8%-83.6%], respectively). Overall survival, any recurrence-free survival, and local recurrence-free survival did not significantly differ between groups. Cancer-specific mortality was associated with age, male sex, American Joint Committee on Cancer stage III, and presence of positive margins. Limitations: Retrospective design, heterogenous baseline characteristics between groups. Conclusion: Excision with narrow margins was not associated with outcome in this cohort, in which most patients had clear margins and postoperative radiation therapy. Residual tumor, mostly found on deep surgical margins, was independently associated with prognosis.

【 授权许可】

Free