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Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

For sentinel lymph node (SLN) metastasis from Merkel cell carcinoma (MCC), the benefit of completion lymph node dissection (CLND) versus radiation therapy (RT) is unclear. This study compares outcomes for patients with SLN metastasis undergoing CLND or RT. We also evaluated positive non-SLNs as a prognostic factor.

Methods

Using a prospective database, we identified MCC patients with SLN metastasis who underwent CLND or RT. At our institution, CLND was recommended for patients with acceptable perioperative risk, while therapeutic RT was offered to those with high perioperative risk. Primary outcomes were MCC-specific survival (MCCSS), disease-free survival (DFS), nodal recurrence-free survival (NRFS), and distant recurrence-free survival (DRFS).

Results

From 2006 to 2017, 163 patients underwent CLND (n = 137) or RT (n = 26). Median follow-up was 1.9 years. CLND had no significant differences for MCCSS (5-year survival 71% vs. 64%, p = 1.0), DFS (52% vs. 61%, p = 0.8), NRFS (76% vs. 91%, p = 0.3), or DRFS (65% vs. 75%, p = 0.3) compared with RT. Patients with positive non-SLNs (n = 44) had significantly worse MCCSS (5-year survival 39% vs. 87%, p < 0.001), DFS (35% vs. 60%, p = 0.005), and DRFS (54% vs. 71%, p = 0.03) compared with negative non-SLNs (n = 93). Multivariate analysis showed positive non-SLNs were independently associated with MCCSS, DFS, and DRFS.

Conclusions

CLND and RT may have similar outcomes for MCC patients with SLN metastasis when treatment aligns with our institutional practices. For patients undergoing CLND, positive non-SLNs is an important prognostic factor associated with poor survival and distant recurrence. This high-risk group should be considered for adjuvant systemic therapy trials.

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Acknowledgment

The authors would like to acknowledge Sherry Fu for her role as the database manager for our institutional Merkel Cell Carcinoma database.

Funding

Dr. Lee is a National Research Service Award postdoctoral fellow supported by the National Cancer Institute (5T32 CA009672-23). This project was supported by a Clinical and Translational Science Award provided to the Michigan Institute for Clinical & Health Research grant support (CTSA: UL1TR002240).

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, 48109-5932, USA

    Jay S. Lee MD & William R. Burns MD

  2. Department of Dermatology, University of Michigan, Ann Arbor, MI, USA

    Alison B. Durham MD, Christopher K. Bichakjian MD & Kelly L. Harms MD, PhD

  3. Department of Pathology, University of Michigan, Ann Arbor, MI, USA

    Paul W. Harms MD, PhD

  4. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

    James A. Hayman MD, MBA

  5. Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA

    Scott A. McLean MD, PhD

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  1. Jay S. Lee MD
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  2. Alison B. Durham MD
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  3. Christopher K. Bichakjian MD
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  4. Paul W. Harms MD, PhD
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  5. James A. Hayman MD, MBA
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  6. Scott A. McLean MD, PhD
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  8. William R. Burns MD
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Correspondence to William R. Burns MD.

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Lee, J.S., Durham, A.B., Bichakjian, C.K. et al. Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma. Ann Surg Oncol 26, 386–394 (2019). https://doi.org/10.1245/s10434-018-7072-7

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  • DOI: https://doi.org/10.1245/s10434-018-7072-7

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