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Merkel Cell Carcinoma: Changing Practice Patterns and Impact on Recurrence-Free and Overall Survival at a Single Institution and Nationally

Overview
Journal Ann Surg Oncol
Publisher Springer
Specialty Oncology
Date 2021 Sep 8
PMID 34494169
Citations 2
Authors
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Abstract

Background: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Our report describes the evolution of management and characteristics associated with recurrence, disease-specific survival (DSS) and overall survival (OS) in the treatment of MCC.

Methods: A single institution retrospective review of MCC and SEER data to determine factors associated with RFS, DSS, and OS using a multivariable Cox regression on inverse-probability weighted cohorts.

Results: One hundred fifty-nine patients were identified with a median age of 75. Of these, 96% were Caucasian and 60% male. Fifty-eight out of 159 (36%) of all patients were deceased with 21/58 (36%) dead from MCC with a median follow-up of 3.1 years. Institutionally, trends over time demonstrated an increased use of immunotherapy with a concomitant decrease in chemotherapy and decreased use of radiotherapy alone. Institutionally and nationally, there has been increased surgical nodal staging. Institutionally, factors associated with shorter DSS included advanced age, active cigarette smoker (p = 0.002), cT2 disease (p = 0.007), and MCC with unknown primary (p < 0.001). Institutionally, factors associated with shorter OS included ages ≥ 75 years (p < 0.001), an immunocompromised state (p < 0.001), truncal primary site (p = 0.002), and cT2 disease (HR 9.59, p < 0.001).

Conclusion: Changing practice patterns in MCC management have been driven by the adoption of immunotherapy. Our study highlights that competing risks of mortality in MCC patients likely prevents OS from being an accurate surrogate outcome measure to understand factors associated with DSS.

Citing Articles

Merkel cell carcinoma recurrence risk estimation is improved by integrating factors beyond cancer stage: A multivariable model and web-based calculator.

McEvoy A, Hippe D, Lachance K, Park S, Cahill K, Redman M J Am Acad Dermatol. 2023; 90(3):569-576.

PMID: 37984720 PMC: 10922724. DOI: 10.1016/j.jaad.2023.11.020.


Prognostic Value of Radiotherapy and Chemotherapy in Stage I-III Merkel Cell Carcinoma.

Bi A, Yang S, Ding Y, Yu Y, Zhan W, Song T Front Med (Lausanne). 2022; 9:845905.

PMID: 35252278 PMC: 8894769. DOI: 10.3389/fmed.2022.845905.

References
1.
Nghiem P, Bhatia S, Lipson E, Sharfman W, Kudchadkar R, Brohl A . Durable Tumor Regression and Overall Survival in Patients With Advanced Merkel Cell Carcinoma Receiving Pembrolizumab as First-Line Therapy. J Clin Oncol. 2019; 37(9):693-702. PMC: 6424137. DOI: 10.1200/JCO.18.01896. View

2.
Jacobs D, Huang H, Olino K, Weiss S, Kluger H, Judson B . Assessment of Age, Period, and Birth Cohort Effects and Trends in Merkel Cell Carcinoma Incidence in the United States. JAMA Dermatol. 2020; 157(1):59-65. PMC: 7643047. DOI: 10.1001/jamadermatol.2020.4102. View

3.
Paulson K, Park S, Vandeven N, Lachance K, Thomas H, Chapuis A . Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics. J Am Acad Dermatol. 2017; 78(3):457-463.e2. PMC: 5815902. DOI: 10.1016/j.jaad.2017.10.028. View

4.
Kaufman H, Russell J, Hamid O, Bhatia S, Terheyden P, DAngelo S . Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol. 2016; 17(10):1374-1385. PMC: 5587154. DOI: 10.1016/S1470-2045(16)30364-3. View

5.
Jabbour J, Cumming R, Scolyer R, Hruby G, Thompson J, Lee S . Merkel cell carcinoma: assessing the effect of wide local excision, lymph node dissection, and radiotherapy on recurrence and survival in early-stage disease--results from a review of 82 consecutive cases diagnosed between 1992 and 2004. Ann Surg Oncol. 2007; 14(6):1943-52. DOI: 10.1245/s10434-006-9327-y. View