Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: Analysis of 5823 cases as the basis of the first consensus staging system - 24/04/13
, Barry E. Storer, PhD d, , Jayasri G. Iyer, MD a, , Jerri Linn Phillips, MA, CTR e, Christopher K. Bichakjian, MD f, L. Christine Fang, MD b, Timothy M. Johnson, MD f, Nanette J. Liegeois-Kwon, MD, PhD h, Clark C. Otley, MD i, Kelly G. Paulson, PhD a, Merrick I. Ross, MD g, Siegrid S. Yu, MD k, Nathalie C. Zeitouni, MD l, David R. Byrd, MD c, n, Vernon K. Sondak, MD j, Jeffrey E. Gershenwald, MD g, Arthur J. Sober, MD m, Paul Nghiem, MD, PhD a, d, n, ⁎ 
Reprint requests: Paul Nghiem, MD, PhD, 815 Mercer St, Brotman 242, Seattle, WA 98109.Abstract |
Background |
The management of Merkel cell carcinoma (MCC) has been complicated by a lack of detailed prognostic data and by the presence of conflicting staging systems.
Objective |
We sought to determine the prognostic significance of tumor size, clinical versus pathologic nodal evaluation, and extent of disease at presentation and thereby derive the first consensus staging/prognostic system for MCC.
Methods |
A total of 5823 prospectively enrolled MCC cases from the National Cancer Data Base had follow-up data (median 64 months) and were used for prognostic analyses.
Results |
At 5 years, overall survival was 40% and relative survival (compared with age- and sex-matched population data) was 54%. Among all MCC cases, 66% presented with local, 27% with nodal, and 7% with distant metastatic disease. For cases presenting with local disease only, smaller tumor size was associated with better survival (stage I, ≤2 cm, 66% relative survival at 5 years; stage II, >2 cm, 51%; P < .0001). Patients with clinically local-only disease and pathologically proven negative nodes had better outcome (76% at 5 years) than those who only underwent clinical nodal evaluation (59%, P < .0001).
Limitations |
The National Cancer Data Base does not capture disease-specific survival. Overall survival for patients with MCC was therefore used to calculate relative survival based on matched population data.
Conclusion |
Although the majority (68%) of patients with MCC in this nationwide cohort did not undergo pathologic nodal evaluation, this procedure may be indicated in many cases as it improves prognostic accuracy and has important treatment implications for those found to have microscopic nodal involvement.
Il testo completo di questo articolo è disponibile in PDF.Key words : clinical staging, Merkel cell carcinoma, neuroendocrine carcinoma of the skin, pathologic staging, prognosis, sentinel lymph node biopsy, staging
Abbreviations used : AJCC, F/U, MCC, NCDB, TNM
Mappa
| Dr Lemos is currently affiliated with the Department of Dermatology, Emory University, Atlanta, GA. |
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| Supported by National Institutes of Health (NIH) K02-AR50993; American Cancer Society (ACS) RSG-08-115-01-CCE; ACS Jerry Wachter Merkel Cell Carcinoma (MCC) Fund; NIH K24-CA139052; an unrestricted educational grant from Schering Pharmaceutical, Kenilworth, NJ; the David & Rosalind Bloom Endowment for MCC Research; and the University of Washington MCC Patient Gift Fund. |
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| Conflicts of interest: None declared. |
Vol 63 - N° 5
P. 751-761 - novembre 2010 Ritorno al numero
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