Clinical benefit of baseline imaging in Merkel cell carcinoma: Analysis of 584 patients - 11/01/21
Abstract |
Background |
Merkel cell carcinoma (MCC) guidelines derive from melanoma and do not recommend baseline cross-sectional imaging for most patients. However, MCC is more likely to have metastasized at diagnosis than melanoma.
Objective |
To determine how often baseline imaging identifies clinically occult MCC in patients with newly diagnosed disease with and without palpable nodal involvement.
Methods |
Analysis of 584 patients with MCC with a cutaneous primary tumor, baseline imaging, no evident distant metastases, and sufficient staging data.
Results |
Among 492 patients with clinically uninvolved regional nodes, 13.2% had disease upstaged by imaging (8.9% in regional nodes, 4.3% in distant sites). Among 92 patients with clinically involved regional nodes, 10.8% had disease upstaged to distant metastatic disease. Large (>4 cm) and small (<1 cm) primary tumors were both frequently upstaged (29.4% and 7.8%, respectively). Patients who underwent positron emission tomography–computed tomography more often had disease upstaged (16.8% of 352), than those with computed tomography alone (6.9% of 231; P = .0006).
Limitations |
This was a retrospective study.
Conclusions |
In patients with clinically node-negative disease, baseline imaging showed occult metastatic MCC at a higher rate than reported for melanoma (13.2% vs <1%). Although imaging is already recommended for patients with clinically node-positive MCC, these data suggest that baseline imaging is also indicated for patients with clinically node-negative MCC because upstaging is frequent and markedly alters management and prognosis.
Le texte complet de cet article est disponible en PDF.Key words : baseline imaging, clinical guidelines, CT, distant metastasis, MCC, melanoma, Merkel cell carcinoma, nodal metastasis, nonmelanoma skin cancer, occult disease, PET-CT, scans, sentinel lymph node biopsy, skin cancer, SLNB, staging
Abbreviations used : CT, MCC, NCCN, NNI, PET-CT, PPV, SLNB
Plan
| Authors Singh and Alexander are cofirst authors. Drs Paulson and Nghiem contributed equally to this article. |
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| Funding sources: Supported in part by the National Institutes of Health/National Cancer Institute (grants P30 CA015704, 1P01CA-225517-01A1, and T32CA009515), Fred Hutchinson Cancer Research Center Integrated Immunotherapy Research Core, Society for Immunotherapy of Cancer-Merck Cancer Immunotherapy Clinical Fellowship, and the Merkel cell carcinoma Patient Gift Fund at the University of Washington. The funding agencies did not participate in design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. |
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| Disclosure: Dr Akaike has received grant support from Nihon Medi-Physics Co, Ltd. |
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| Dr Bhatia has received grant support from Bristol Myers Squibb, Merck, Novartis, Emmanuel Merck, Darmstadt (EMD) Serono, Oncosec, Immune Design, and NantKwest, as well as honoraria (for advisory board participation) from Bristol Myers Squibb, EMD-Serono and Sanofi-Genzyme. Dr Paulson has received grant support from SITC-Merck, Bluebird Bioscience, and EMD Serono. Dr Nghiem reports receiving grant support from EMD Serono and Bristol Myers Squibb as well as honoraria from Merck and EMD-Serono. Authors Singh and Alexander and Drs Lewis, McEvoy, Byrd, and Behnia have no conflicts of interest to declare. |
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| IRB approval status: Reviewed and approved by the Fred Hutchinson Cancer Research Center IRB (approval no. 6585). |
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| Reprints are not available from the authors. |
Vol 84 - N° 2
P. 330-339 - février 2021 Retour au numéro
Article précédent
- Improved survival in women versus men with merkel cell carcinoma
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