Improved survival in women versus men with merkel cell carcinoma - 15/05/20

Doi : 10.1016/j.jaad.2020.02.034

Moses Tam, MD ^a, Michael Luu, MPH ^b, Christopher A. Barker, MD ^c, Nima M. Gharavi, MD, PhD ^d, Omid Hamid, MD ^e,^f, Stephen L. Shiao, MD, PhD ^g, Anthony T. Nguyen, MD, PhD ^g, Diana J. Lu, MD ^g, Allen S. Ho, MD ^h, Zachary S. Zumsteg, MD ^g,^⁎
^a Department of Radiation Oncology, New York University Langone Health, New York, New York
^b Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California
^c Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
^d Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
^e The Angeles Clinic and Research Institute, Los Angeles, California
^f Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California
^g Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
^h Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California

^∗Correspondence to: Zachary S. Zumsteg, MD, Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048.Department of Radiation OncologyCedars-Sinai Medical Center8700 Beverly BlvdLos AngelesCA90048

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Abstract

Background

Studies have observed that women have better outcomes than men in melanoma, but less is known about the influence of sex differences on outcomes for other aggressive cutaneous malignancies.

Objective

To investigate whether women and men have disparate outcomes in Merkel cell carcinoma (MCC).

Methods

Patients with nonmetastatic MCC undergoing surgery and lymph node evaluation were identified from the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier analysis and Cox proportional hazards regression models were used for overall survival, and competing-risks analysis and Fine-Gray models were used for cause-specific and other-cause mortality.

Results

The NCDB cohort (n = 4178) included 1516 (36%) women. Women had a consistent survival advantage compared with men in propensity score–matched analysis (66.0% vs 56.8% at 5 years, P < .001) and multivariable Cox regression (hazard ratio, 0.68; 95% confidence interval, 0.61-0.75; P < .001). Similarly, women had a survival advantage in the SEER validation cohort (n = 1202) with 457 (38.0%) women, which was entirely due to differences in MCC-specific mortality (5-year cumulative incidence: 16.4% vs 26.7%, P = .002), with no difference in other-cause mortality (16.8% vs 17.8%, P = .43) observed in propensity score–matched patients.

Limitations

Potential selection bias from a retrospective data set.

Conclusion

In MCC, women have improved survival compared with men, driven by MCC-related mortality.

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Key words : Merkel cell cancer, National Cancer Data Base, NCDB, SEER, sex

Abbreviations used : CI, HR, MCC, NCDB, OS, SEER

Plan

Materials and methods

Data sources

NCDB patient selection

SEER database patient selection

Statistical methods

Results

NCDB discovery data set

SEER database validation data set

Sensitivity analysis

Discussion

	Funding sources: None.
	Disclosure: Dr Zumsteg has served on the external advisory board for the Scripps Proton Therapy Center and has been a consultant for EMD Serono. Dr Tam; Mr Luu; Drs Barker, Gharavi, Hamid, Shiao, Nguyen, Lu, and Ho have no conflicts of interest to declare.
	IRB approval status: Reviewed and exempted by the Cedars-Sinai IRB.
	Reprints not available from the authors.