title: Factors influencing relapse-free survival in Merkel cell carcinoma of the lower limb--a review of 60 cases.
abstract: OBJECTIVE
  Factors affecting relapse-free survival (RFS) in patients with Merkel cell carcinoma (MCC) of the lower limb were reviewed.
  
  
  METHODS
  The records of 60 patients from 1986 to 2005 with a diagnosis of MCC of the lower limb or buttock were retrospectively reviewed. The patients were treated with curative intent with surgery, radiation, or chemotherapy.
  
  
  RESULTS
  The 5-year overall survival, disease-specific survival, and RFS were 53%, 61%, and 20%, respectively. Factors influencing RFS were analyzed using univariate analysis. It appeared that recurrent disease worsened RFS (p = 0.03) and the addition of any radiotherapy improved RFS (p <0.001), as did radiotherapy to the inguinal nodes (p = 0.01) or primary site and inguinal nodes (p = 0.003). Age, surgical margins, and stage were not statistically significant. On multivariate analysis, the only significant factor was the addition of radiotherapy (hazard ratio = 0.51 p = 0.03).
  
  
  CONCLUSIONS
  The addition of radiotherapy improves RFS compared with surgery alone. Elective treatment should be given to the inguinal nodes to reduce the risk of relapse.
authors.affiliation: Division of Cancer Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia. michael_poulsen@health.qld.gov.au
authors.forename: Michael
authors.initials: M
authors.lastname: Poulsen
authors.forename: Caroline
authors.initials: C
authors.lastname: Round
authors.forename: Jacqui
authors.initials: J
authors.lastname: Keller
authors.forename: Lee
authors.initials: L
authors.lastname: Tripcony
authors.forename: Michael
authors.initials: M
authors.lastname: Veness
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015266:Carcinoma, Merkel Cell / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D035002:Lower Extremity; D015182:Lymphatic Irradiation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000532:radiotherapy; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery