The Role of Sentinel Lymph Node Biopsy in the Management of Merkel Cell Carcinoma: A Systematic Review and Meta-analysis

Author:

Kanakopoulos Dimitrios12,Lacey Hester3,Payne Anna1,Houlihan Maria1,Riyat Harjoat1,Wheelan Rhys4,Cubitt Jonathan2,Totty Joshua P.15

Affiliation:

1. Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom

2. Department of Plastic and Reconstructive Surgery, Swansea Bay University Health Board, Swansea, United Kingdom

3. Department of Plastic Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom

4. Library and Knowledge Services, Swansea Bay University Health Board, Swansea, United Kingdom

5. Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom.

Abstract

Background: Merkel cell carcinoma (MCC) is a rare cutaneous malignancy with high metastatic potential. Sentinel lymph node biopsy (SLNB) is used to assess locoregional spread, facilitate staging, and inform prognosis. Positive nodal status is associated with higher recurrence rates and reduced overall survival. Methods: A systematic search was conducted. Eligible articles included patients diagnosed with MCC, who would be candidates for or who had SLNB. The Covidence tool was used for screening and data extraction, including additional treatments, disease-free survival, overall survival, and recurrence. Methodological quality was assessed using the Newcastle-Ottowa Scale criteria. Results: SLNB was associated with increased likelihood of completion lymphadenectomy (223 versus 41), regional radiotherapy (2167 versus 808), and systemic chemotherapy (138 versus 31). Overall survival for patients undergoing SLNB was 81% at 2 years, 75% at 3 years, and 72% at 5 years (odds ratio: 0.79). Hazard ratio for positive SLNB versus negative was 3.36 (P < 0.001). Five-year disease recurrence was 23.3% in patients undergoing SLNB. Conclusions: Lymph node metastases are associated with reduced overall survival and increased recurrence of MCC. Determining nodal status early can inform prognosis, facilitate staging, and determine need for adjuvant treatment. Adjuvant treatments are associated with reduced mortality and improved overall survival; SLNB is an important influencer of their use. Early prophylactic intervention should be considered in MCC in both positive and negative nodal status to improve overall outcomes. Widespread use of SLNB will allow more accurate assessment of the role of nodal status on adjuvant treatment and long-term outcomes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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