A multivariable disease-specific model enhances prognostication beyond current Merkel cell carcinoma staging: An international cohort study of 10,958 patients - 19/02/25
, Sophie Erdmann, MBChB, BSc b, Mogdad Alrawi, MBChB, MSc b, Ruth Plummer, BMBCh, DPhil a, c, Sophia Z. Shalhout, PhD d, e, Vern Sondak, MD f, g, Isaac Brownell, MD, PhD h, Penny E. Lovat, MPhil, PhD a, Aidan Rose, BSc Hons, MBChB, PhD a, bAbstract |
Background |
Merkel cell carcinoma (MCC) is a highly aggressive cutaneous malignancy for which accurate prognostication is necessary to support clinical management.
Objective |
(1) To determine which survival endpoint—disease-specific death (DSD) or overall survival (OS)—was better stratified by MCC American Joint Cancer Committee eighth edition staging. (2) To develop a multivariable model for enhanced MCC survival predictions.
Methods |
A retrospective analysis of 10,958 histologically confirmed MCC patients between January 2000 and December 2020 was performed. Patient and tumor features were analyzed from 2 cohorts: a US cohort and an external validation UK cohort. A multivariable Fine and Gray competing risk (FG) model was utilized to account for the competing risk.
Results |
DSD demonstrated greater discriminatory power as a survival endpoint when compared with OS. Multivariate FG analysis identified the most impactful features of DSD: truncal lesions (subdistribution hazard ratios [SHRs] = 1.96, P < .001), age >84 years (SHR = 1.79, P < .001), male sex (SHR = 1.34, P < .001), and marital status (SHR = 1.09, P < .001). A second FG model incorporating those impactful features enhanced survival predictions beyond current MCC staging criteria alone in both the US (C-index 0.75 vs 0.64, P < .001) and external validation UK cohort (C-index 0.77).
Conclusions |
MCC staging can stratify DSD better than OS. Additional patient and tumor features enhanced prognostication beyond current staging systems.
Il testo completo di questo articolo è disponibile in PDF.Key words : AJCC staging, Merkel cell carcinoma, prognostication, SEER, skin cancer, survival
Abbreviations used : AJCC, DSD, MCC, OS, SHR
Mappa
| Funding sources: Dr Andrew was supported by a clinical PhD studentship from Cancer Research United Kingdom (CRUK). Dr Brownell was supported by the NIAMS, NIH intramural research program (ZIA AR041222). Dr Rose was supported by a National Institute for Health and Care Research (NIHR) Clinical Lectureship and NuTH Research Capability Funding. This research was supported by the NIHR Newcastle Biomedical Research Centre awarded to the NuTH, Newcastle University and Cumbria, Northumberland, Tyne, and Wear Foundation Trust. |
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| Patient consent: Not applicable. |
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| IRB approval status: Not applicable. |
Vol 92 - N° 3
P. 520-527 - marzo 2025 Ritorno al numero
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