Analysis of cutaneous Merkel cell carcinoma outcomes after different surgical interventions - 20/03/20

Doi : 10.1016/j.jaad.2018.10.001

Lu Yan, MD, PhD ^a,^⁎ , Ledong Sun, MD, PhD ^a, Zhiguang Guan, MD ^b, Shanshan Wei, MD ^a, Yanru Wang, MD, PhD ^c, Pengfei Li, MD ^b
^a Department of Dermatology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province
^b Department of Plastic Surgery and Burn, Taishan People's Hospital, Guangzhou, Guangdong Province
^c Department of Radiotherapy and Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province

^∗Correspondence to: Lu Yan, MD, PhD, Zhujiang Hospital, Haizhu District, Guangzhou 510282, China.Zhujiang HospitalHaizhu DistrictGuangzhou510282China

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 20 March 2020

Abstract

Background

Current guidelines recommend local excision margin (EM) with 1 to 2 cm on primary Merkel cell carcinoma (MCC) sites.

Objective

We compared survival outcomes of patients with MCC who were treated with different surgical interventions.

Methods

A retrospective analysis of MCC cases in the Surveillance, Epidemiology, and End Results database was performed using the Kaplan–Meier, competing risk, and Cox proportional hazards regression model analyses. Influence of age, T stage, American Joint Committee on Cancer stage, adjuvant radiotherapy, and other subgroups were also analyzed by pairwise log rank test.

Results

Our results indicated a significant association between local destruction method and inferior survival, while an EM >2 cm showed significantly higher overall survival. In addition, the competing risk analysis depicted a similar trend as the Kaplan–Meier analysis, and considerably reduced estimated cumulative incidence. Further subgroup pairwise analysis demonstrated that the EM >2 cm method had better survival in patients who were <60 years of age, having smaller tumor diameters (T1 and T2) or having undergone adjuvant radiotherapy (P < .05). In contrast, different EMs did not show any significant association with survival rate in patients ≥75 years of age or stage III tumors.

Limitations

This study was not prospectively randomized without relapse data.

Conclusions

It is challenging to make optimal EM recommendations, because surgical options may depend on individual case situations. Further prospective randomized studies are warranted.

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Key words : cancer-specific survival, competing risk analysis, excision margin, Merkel cell carcinoma, Mohs micrographic surgery, overall survival