Merkel Cell Carcinoma: Characteristics Associated with Recurrence Free Survival and Improved Overall Survival at a Single Institution
Andrew C. Esposito1, Daniel Jacobs2, Stephan Ariyan3, Anjela Galan4, Harriet Kluger5, James Clune3, Sarah Weiss5, Thuy Tran5, Kelly Olino1
1Department of Surgery, Division of Surgical Oncology, Yale-New Haven Hospital, New Haven, Connecticut, United States, 2Yale School of Medicine, New Haven, Connecticut, United States, 3Department of Surgery Division of Plastic Surgery, Yale School of Medicine, New Haven, Connecticut, United States, 4Department of Dermatology and Pathology, Yale School of Medicine, New Haven, Connecticut, United States, 5Department of Medicine, Division of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, United States
Objective
Merkel cell carcinoma (MCC) is a rare and deadly cancer with an increasing incidence in the United states. Understanding factors associated with recurrence free survival (RFS), disease specific survival (DSS), and overall survival (OS) is imperative in treating this malignancy.
Design
Retrospective review of electronic medical records. Multivariate survival analyses.
Setting
A single academic tertiary care hospital.
Patients
174 patients were identified but 15 were excluded due to incomplete clinic-pathologic data, leaving 159 patients evaluable.
Outcomes
The effect of demographic characteristics, clinical and pathological staging, and treatment regimen on RFS, OS, and DSS.
Results
Lower RFS was associated with age >85 years (HR=3.32, p=0.045), cT2 (HR=2.66, p=0.017), and cT3 or cT4 (HR=4.80, p=0.004). Lower DSS was associated with age 75-79 (HR=6.09, p=0.050) and > 85 (HR=5.02, p=0.015), active cigarette smokers (HR=14.68, p=0.002), cT2 (HR=6.37, p=0.007), and unknown cT stage (HR=21.79, p<0.001). Worse OS was associated with older age, an immunocompromised state (HR=10.62, p<0.001), trunk as the primary site (HR=7.11, p=0.002), cT2 disease (HR=9.59, p<0.001). Improved OS was associated with female sex (HR=0.35, p=0.006) and receipt of surgery with lymph node evaluation (HR=0.44, p=0.019).
Conclusions
Worse DSS and OS were both associated with older age and cT2 disease while unknown cT stage and active cigarette smoking was only associated with worse DSS. In contrast, an immunocompromised state and truncal disease were associated with lower OS.
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