Relationships among primary tumor size, number of involved nodes, and survival for 8044 cases of Merkel cell carcinoma - 14/03/14

Doi : 10.1016/j.jaad.2013.11.031

Jayasri G. Iyer, MD ^a, Barry E. Storer, PhD ^c, Kelly G. Paulson, MD, PhD ^a, Bianca Lemos, MD ^a,^d, Jerri Linn Phillips, MA, CTR ^e, Christopher K. Bichakjian, MD ^g, Nathalie Zeitouni, MD ^h, Jeffrey E. Gershenwald, MD ⁱ, Vernon Sondak, MD ^j, Clark C. Otley, MD ^k, Siegrid S. Yu, MD ^l, Timothy M. Johnson, MD ^g, Nanette J. Liegeois, MD ^m, David Byrd, MD ^b,ⁿ, Arthur Sober, MD ^f, Paul Nghiem, MD, PhD ^a,^c,^n,^⁎
^a Department of Medicine/Dermatology, University of Washington, Seattle, Washington
^b Department of Surgery, University of Washington, Seattle, Washington
^c Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
^d Department of Dermatology, Emory University, Atlanta, Georgia
^e Commission on Cancer of the American College of Surgeons, Chicago, Illinois
^f Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
^g Department of Dermatology, University of Michigan Health System, Ann Arbor
^h Roswell Park Cancer Institute, Buffalo, New York
ⁱ Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Taxas
^j H. Lee Moffitt Cancer Center and Research Institute and the University of South Florida, Tampa, Florida
^k Department of Dermatology, Mayo Clinic, Rochester
^l Department of Dermatology, University of California at San Francisco, San Francisco, California
^m Department of Oncology and Plastic Surgery, Johns Hopkins, Baltimore, Maryland
ⁿ Seattle Cancer Care Alliance, Seattle, Washington

^∗Reprint requests: Paul Nghiem, MD, PhD, Department of Medicine/Dermatology, University of Washington, 850 Republican St, Seattle, WA 98109.

Abstract

Background

The effects of primary tumor size on nodal involvement and of number of involved nodes on survival have not, to our knowledge, been examined in a national database of Merkel cell carcinoma (MCC).

Objective

We sought to analyze a retrospective cohort of patients with MCC from the largest US national database to assess the relationships between these clinical parameters and survival.

Methods

A total of 8044 MCC cases in the National Cancer Data Base were analyzed.

Results

There was a 14% risk of regional nodal involvement for 0.5-cm tumors that increased to 25% for 1.7-cm (median-sized) tumors and to more than 36% for tumors 6 cm or larger. The number of involved nodes was strongly predictive of survival (0 nodes, 76% 5-year relative survival; 1 node, 50%; 2 nodes, 47%; 3-5 nodes, 42%; and ≥6 nodes, 24%; P < .0001 for trend). Younger and/or male patients were more likely to undergo pathological nodal evaluation.

Limitations

The National Cancer Data Base does not capture disease-specific survival. Hence, relative survival was calculated by comparing overall survival with age- and sex-matched US population data.

Conclusion

Pathologic nodal evaluation should be considered even for patients with small primary MCC tumors. The number of involved nodes is strongly predictive of survival and may help improve prognostic accuracy and management.

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Key words : average tumor size, Merkel cell carcinoma, National Cancer Data Base, neuroendocrine carcinoma of the skin, nodal spread, prognosis, regional node metastasis, sentinel lymph node biopsy

Abbreviations used : CI, HR, MCC, NCDB

Plan

	Supported by National Institutes of Health (NIH) K02-AR50993, American Cancer Society RSG-08-115-01-CCE, NIH K24-CA139052, the David and Rosalind Bloom Endowment for Merkel Cell Carcinoma Research, the Michael Piepkorn Endowment, and the University of Washington Merkel Cell Carcinoma Patient Gift Fund.
	Conflicts of interest: None declared.

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Vol 70 - N° 4

P. 637-643 - avril 2014 Retour au numéro

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Relationships among primary tumor size, number of involved nodes, and survival for 8044 cases of Merkel cell carcinoma - 14/03/14

Abstract

Background

Objective

Methods

Results

Limitations

Conclusion

Plan

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