AIM: To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone. METHODS: Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n=42) or staged with sentinel lymph node biopsy (n=21), and clinically positive nodes underwent lymph node dissection (n=32). RESULTS: Median follow-up was 65 months. A total of 45 (47%) patients relapsed, with 80% of the recurrences occurring within 2 years and 96% within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52% and 67%, respectively. CCI of local 5-year recurrence was 5% for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19%, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2% (P=0.007). Comparing patients with <or=2 versus >2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0% versus 39% (P=0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37% versus 12%; P=0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22%, and patients with occult primary had a 5-year distant-recurrence CCI of 49% (P=0.023). The 5-year DSS rate was 80% for pathologically node-negative patients. CONCLUSION: The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.
AIM: To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone. METHODS: Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n=42) or staged with sentinel lymph node biopsy (n=21), and clinically positive nodes underwent lymph node dissection (n=32). RESULTS: Median follow-up was 65 months. A total of 45 (47%) patients relapsed, with 80% of the recurrences occurring within 2 years and 96% within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52% and 67%, respectively. CCI of local 5-year recurrence was 5% for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19%, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2% (P=0.007). Comparing patients with <or=2 versus >2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0% versus 39% (P=0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37% versus 12%; P=0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22%, and patients with occult primary had a 5-year distant-recurrence CCI of 49% (P=0.023). The 5-year DSS rate was 80% for pathologically node-negative patients. CONCLUSION: The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.
Authors: Franz O Smith; Binglin Yue; Suroosh S Marzban; Brooke L Walls; Michael Carr; Ryan S Jackson; Christopher A Puleo; Tapan Padhya; C Wayne Cruse; Ricardo J Gonzalez; Amod A Sarnaik; Michael J Schell; Ronald C DeConti; Jane L Messina; Vernon K Sondak; Jonathan S Zager Journal: Cancer Date: 2015-06-02 Impact factor: 6.860
Authors: Shailender Bhatia; Barry E Storer; Jayasri G Iyer; Ata Moshiri; Upendra Parvathaneni; David Byrd; Arthur J Sober; Vernon K Sondak; Jeffrey E Gershenwald; Paul Nghiem Journal: J Natl Cancer Inst Date: 2016-05-31 Impact factor: 13.506
Authors: Ryan C Fields; Klaus J Busam; Joanne F Chou; Katherine S Panageas; Melissa P Pulitzer; Dennis H Kraus; Mary S Brady; Daniel G Coit Journal: Ann Surg Oncol Date: 2011-03-24 Impact factor: 5.344