American Surgical Association

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500 Patients Treated for Merkel Cell Carcinoma at a Single Institution
Ryan C Fields, MD*, Klaus Busam, MD*, Joanne F Chou, MD*, Katherine S Panageas, MD*, Melissa P Pulitzer, MD*, Dennis H Kraus, MD*, Mary S Brady, MD*, Daniel G Coit, MD
Memorial Sloan-Kettering Cancer Center, New York, NY

OBJECTIVE:
Merkel cell carcinoma (MCC) is a rare cutaneous neoplasm. Staging and treatment are based on studies which incompletely characterize the disease. Here we present the largest series of patients with MCC and identify factors associated with survival.
METHODS:
Review of a prospective database was performed. Overall survival (OS) was estimated by Kaplan-Meier and Cox regression. Disease -specific survival (DSS) was analyzed by competing risk methods.
RESULTS:
500 patients with MCC were prospectively identified. Median follow-up was 3 years. 51% of patients died during follow-up: 51% DOD, 49% DOC. 5-year OS was 56% and cumulative incidence of death from MCC at 5 years was 30%. Stage and lymphovascular invasion (LVI) are predictive of survival (Table). Notably, patients with clinically positive lymph nodes (3b) have decreased survival compared to microscopically positive (3a) or negative lymph nodes (1 and 2), while there is no difference in survival between stage 3a versus stage 1/2 (Figure). Importantly, only one patient without LVI died of MCC during follow-up.
CONCLUSIONS:
OS is a poor outcome measure in MCC. Presence of LVI and clinically, but not microscopically, positive lymph nodes are associated with decreased DSS. Emphasis on these factors into MCC staging and treatment recommendations should be considered.


Variables Associated with Overall and Disease-Specific Survival
VariableOVERALL SURVIVALDISEASE-SPECIFIC SURVIVAL
Univariate HR (95% CI); p valueMultivariate HR (95% CI); p valueUnivariate HR (95% CI); p valueMultivariate HR (95% CI); p value
Age (per 10 year increase)1.4 (1.24-1.62); <0.011.4 (1.26-1.65); <0.010.98 (0.82-1.75); 0.91--
Size of Primary Tumor (per 1cm increase)1.1 (1.04-1.16); <0.01NS1.12 (1.10-1.30); <0.01NS
Presence of Lymphovascular Invasion in Primary Tumor2.4 (1.74-3.45); <0.011.7 (1.16-2.58); <0.01NANA
Positive Margin3.3 (1.86-5.74); <0.01NS3.23 (1.59-6.54); <0.01NS
Stage: 4 v. 17.8 (4.51-13.0); <0.018.0 (4.4-14.0); <0.0120.1 (11-36); <0.0120.1 (11-36); <0.01
Stage: 3b v. 12.5 (1.84-3.60); <0.012.4 (1.64-3.74); <0.016.20 (3.6-10.4); <0.016.20 (3.6-10.4); <0.01
Stage: 3a v. 11.2 (0.71-2.01); NS0.8 (0.48-1.50); NS1.70 (0.70-4.1); NSNS
Stage: 2 v. 11.1 (0.72-1.73); NS1.1 (0.69-1.66); NS1.60 (0.64-3.7); NSNS


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