Merkel cell carcinoma: The prognostic implications of an occult primary in stage IIIB (nodal) disease - 11/08/12
Abstract |
Background |
Merkel cell carcinoma is a highly aggressive cutaneous malignancy with a high rate of lymph node and distant metastatic disease. Approximately one third of patients present with stage IIIB (nodal) disease.
Objective |
This cohort study was performed to analyze the outcome of patients with stage IIIB disease with or without an occult primary.
Methods |
The details of 91 patients with stage IIIB (nodal) Merkel cell carcinoma treated curatively between 1985 and 2010 at 3 tertiary referral hospitals in Australia were reviewed. Kaplan-Meier plots were used with the primary end point being overall survival. Secondary end points were disease-free survival and relapse-free survival. A multivariate Cox regression analysis was performed for known prognostic factors.
Results |
Of 91 patients with stage IIIB (nodal) disease, 36 (40%) had an occult primary. A total of 78 patients (86%) had surgery and 79 patients (87%) had definitive or adjuvant radiotherapy. With a median follow-up of 4.3 years, those with an occult primary did significantly better in terms of overall survival, disease-free survival, and relapse-free survival. On multivariate analysis, occult primary and patient age were the only factors predicting survival with hazard ratios of 0.30 (95% confidence interval 0.13-0.67) and 1.64 (95% confidence interval 1.13-2.38), respectively.
Limitations |
This is a retrospective study over several decades with patients treated using various modalities.
Conclusion |
This study indicates that for patients with stage IIIB (nodal) Merkel cell carcinoma, the presence of an occult primary confers a significantly better prognosis that may have implications in the future staging and treatment of patients with stage III disease.
Le texte complet de cet article est disponible en PDF.Key words : Merkel cell carcinoma, nodes, radiotherapy, staging
Abbreviations used : MCC, OS, RFS
Plan
Funding sources: None. |
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Conflicts of interest: None declared. |
Vol 67 - N° 3
P. 395-399 - septembre 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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