BACKGROUND: Merkel cell carcinoma is a highly aggressive cutaneous malignancy with a high rate of lymph node and distant metastatic disease. Approximately one third of patients present with stage IIIB (nodal) disease. OBJECTIVE: This cohort study was performed to analyze the outcome of patients with stage IIIB disease with or without an occult primary. METHODS: The details of 91 patients with stage IIIB (nodal) Merkel cell carcinoma treated curatively between 1985 and 2010 at 3 tertiary referral hospitals in Australia were reviewed. Kaplan-Meier plots were used with the primary end point being overall survival. Secondary end points were disease-free survival and relapse-free survival. A multivariate Cox regression analysis was performed for known prognostic factors. RESULTS: Of 91 patients with stage IIIB (nodal) disease, 36 (40%) had an occult primary. A total of 78 patients (86%) had surgery and 79 patients (87%) had definitive or adjuvant radiotherapy. With a median follow-up of 4.3 years, those with an occult primary did significantly better in terms of overall survival, disease-free survival, and relapse-free survival. On multivariate analysis, occult primary and patient age were the only factors predicting survival with hazard ratios of 0.30 (95% confidence interval 0.13-0.67) and 1.64 (95% confidence interval 1.13-2.38), respectively. LIMITATIONS: This is a retrospective study over several decades with patients treated using various modalities. CONCLUSION: This study indicates that for patients with stage IIIB (nodal) Merkel cell carcinoma, the presence of an occult primary confers a significantly better prognosis that may have implications in the future staging and treatment of patients with stage III disease.
BACKGROUND:Merkel cell carcinoma is a highly aggressive cutaneous malignancy with a high rate of lymph node and distant metastatic disease. Approximately one third of patients present with stage IIIB (nodal) disease. OBJECTIVE: This cohort study was performed to analyze the outcome of patients with stage IIIB disease with or without an occult primary. METHODS: The details of 91 patients with stage IIIB (nodal) Merkel cell carcinoma treated curatively between 1985 and 2010 at 3 tertiary referral hospitals in Australia were reviewed. Kaplan-Meier plots were used with the primary end point being overall survival. Secondary end points were disease-free survival and relapse-free survival. A multivariate Cox regression analysis was performed for known prognostic factors. RESULTS: Of 91 patients with stage IIIB (nodal) disease, 36 (40%) had an occult primary. A total of 78 patients (86%) had surgery and 79 patients (87%) had definitive or adjuvant radiotherapy. With a median follow-up of 4.3 years, those with an occult primary did significantly better in terms of overall survival, disease-free survival, and relapse-free survival. On multivariate analysis, occult primary and patient age were the only factors predicting survival with hazard ratios of 0.30 (95% confidence interval 0.13-0.67) and 1.64 (95% confidence interval 1.13-2.38), respectively. LIMITATIONS: This is a retrospective study over several decades with patients treated using various modalities. CONCLUSION: This study indicates that for patients with stage IIIB (nodal) Merkel cell carcinoma, the presence of an occult primary confers a significantly better prognosis that may have implications in the future staging and treatment of patients with stage III disease.
Authors: Jeremiah L Deneve; Jane L Messina; Suroosh S Marzban; Ricardo J Gonzalez; Brooke M Walls; Kate J Fisher; Y Ann Chen; C Wayne Cruse; Vernon K Sondak; Jonathan S Zager Journal: Ann Surg Oncol Date: 2012-01-21 Impact factor: 5.344
Authors: Dirk Schadendorf; Paul Nghiem; Shailender Bhatia; Axel Hauschild; Philippe Saiag; Lisa Mahnke; Subramanian Hariharan; Howard L Kaufman Journal: Oncoimmunology Date: 2017-08-31 Impact factor: 8.110
Authors: Maryam M Asgari; Monica M Sokil; E Margaret Warton; Jayasri Iyer; Kelly G Paulson; Paul Nghiem Journal: JAMA Dermatol Date: 2014-07 Impact factor: 10.282