Narrow resection margins are not associated with mortality or recurrence in patients with Merkel cell carcinoma: A retrospective study - 10/03/21

Doi : 10.1016/j.jaad.2020.11.038

Frédéric Jaouen, MD ^a,^b,^o, Thibault Kervarrec, MD, PhD ^a,^c,^d, Agnès Caille, MD, PhD ^a,^e,^m, Yannick Le Corre, MD ^f,^o, Brigitte Dreno, MD, PhD ^g,^o, Eric Esteve, MD ^h,^o, Ewa Wierzbicka-Hainaut, MD ^i,^o, Hervé Maillard, MD ^j,^o, Monica Dinulescu, MD ^k,^o, Astrid Blom, MD ^l, Philippe Saïag, MD, PhD ^l,ⁿ, Mahtab Samimi, MD, PhD ^a,^b,^d,^o,^⁎
^a Université François Rabelais, Tours, France
^b Dermatology Department, Tours University Hospital, Tours, France
^c Pathology Department, Tours University Hospital, Tours, France
^d Biologie des Infections à Polyomavirus, ISP 1282 INRA University of Tours, Tours, France
^e Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
^f Dermatology Department, Angers University Hospital, Angers, France
^g Dermatology Department, Nantes University Hospital, Nantes, France
^h Dermatology Department, Orléans Regional Hospital, Orléans, France
ⁱ Dermatology Department, Poitiers University Hospital, Poitiers, France
^j Dermatology Department, Le Mans Regional Hospital, Le Mans, France
^k Dermatology Department, Rennes University Hospital, Rennes, France
^l Dermatology Department, Ambroise Paré Hospital, Boulogne-Billancourt, France
^m INSERM Centre d'Investigation Clinique 1415, Tours University Hospital, Tours, France
ⁿ University of Paris-Saclay-Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
^o Institut Dermatologique du Grand Ouest (IDGO), France

^∗Correspondence to: Mahtab Samimi, MD, PhD, Department of Dermatology, CHU Tours, Avenue de la République, 37170 Tours, France.Department of DermatologyCHU ToursAvenue de la RépubliqueTours37170France

Abstract

Background

Wide local excision constitutes the standard of care for Merkel cell carcinoma, but the optimal margin width remains controversial.

Objectives

To assess whether narrow margins (0.5-1 cm) were associated with outcome.

Methods

Patients were recruited from a retrospective French multicentric cohort and included if they had had excision of primary tumor with minimum lateral margins of 0.5 cm. Factors associated with mortality and recurrence were assessed by multivariate regression.

Results

Among the 214 patients included, 58 (27.1%) had undergone excision with narrow margins (0.5-1 cm) versus 156 (72.9%) with wide margins (>1 cm). During a median follow-up of 50.7 months, cancer-specific survival did not differ between groups (5-year specific survival rate 76.8% [95% confidence interval 61.7%-91.9%] and 76.2% [95% confidence interval 68.8%-83.6%], respectively). Overall survival, any recurrence-free survival, and local recurrence-free survival did not significantly differ between groups. Cancer-specific mortality was associated with age, male sex, American Joint Committee on Cancer stage III, and presence of positive margins.

Limitations

Retrospective design, heterogenous baseline characteristics between groups.

Conclusion

Excision with narrow margins was not associated with outcome in this cohort, in which most patients had clear margins and postoperative radiation therapy. Residual tumor, mostly found on deep surgical margins, was independently associated with prognosis.

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Key words : general surgery, Merkel cell carcinoma, mortality, neoplasms, prognosis, skin surgical margins, wide local excision

Abbreviations used : AJCC, CI, HR, MCC

Plan

Introduction

Patients and methods

Study design, participants, and settings

Inclusion and exclusion criteria

Patient characteristics by size of margins at baseline

Size of margins and death from MCC

Size of margins and MCC recurrence

Size of margins and pattern of recurrence

Characteristics of patients with positive margins

Discussion

	Funding sources: This work was supported by La Ligue Contre le Cancer (Indre-et-Loire, France) and HUGO (Hopitaux Universitaires du Grand Ouest, France).
	The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
	IRB approval status: The work was approved by the Ethics Committee of Tours, France (ID RCB 2009-A01056-51).
	Reprints not available from the authors.

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Vol 84 - N° 4

P. 921-929 - avril 2021 Retour au numéro

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Narrow resection margins are not associated with mortality or recurrence in patients with Merkel cell carcinoma: A retrospective study - 10/03/21

Abstract

Background

Objectives

Methods

Results

Limitations

Conclusion

Plan

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