Julie R Howle1, Michael J Veness. 1. Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales; Surgical Oncology Unit and Department of Radiation Oncology, Westmead Hospital, Sydney, New South Wales; University of Sydney, Sydney, New South Wales.
Abstract
BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high rate of nodal metastasis. The American Joint Committee on Cancer staging system subclassifies nodal disease into microscopic and macroscopic groups based on prognosis. OBJECTIVE: To compare the outcome of patients with microscopic and macroscopic nodal metastases. MATERIALS AND METHODS: Patients were identified from a database of 180 patients with MCC who presented to Westmead Hospital, Sydney, Australia, from 1980 to 2013. Disease-free survival (DFS), overall survival (OS), and follow-up were calculated using Kaplan-Meier curves and compared using the log-rank (Mantel-Cox) test. RESULTS: Forty-one patients were diagnosed with node-positive MCC; 11 patients had microscopic nodal metastases, with five (45%) relapsing, and 30 had macroscopic disease, with 17 (57%) relapsing. There was no significant difference in DFS (p = .93) or OS (p = .63) between the two groups. CONCLUSION: The nonsignificant difference in DFS and OS suggest that even microscopic nodal metastases can predict a poor outcome. Because more than half of patients subsequently relapse, often at a distant site, there is a need to develop an effective systemic treatment.
BACKGROUND:Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high rate of nodal metastasis. The American Joint Committee on Cancer staging system subclassifies nodal disease into microscopic and macroscopic groups based on prognosis. OBJECTIVE: To compare the outcome of patients with microscopic and macroscopic nodal metastases. MATERIALS AND METHODS:Patients were identified from a database of 180 patients with MCC who presented to Westmead Hospital, Sydney, Australia, from 1980 to 2013. Disease-free survival (DFS), overall survival (OS), and follow-up were calculated using Kaplan-Meier curves and compared using the log-rank (Mantel-Cox) test. RESULTS: Forty-one patients were diagnosed with node-positive MCC; 11 patients had microscopic nodal metastases, with five (45%) relapsing, and 30 had macroscopic disease, with 17 (57%) relapsing. There was no significant difference in DFS (p = .93) or OS (p = .63) between the two groups. CONCLUSION: The nonsignificant difference in DFS and OS suggest that even microscopic nodal metastases can predict a poor outcome. Because more than half of patients subsequently relapse, often at a distant site, there is a need to develop an effective systemic treatment.
Authors: Kelly L Harms; Mark A Healy; Paul Nghiem; Arthur J Sober; Timothy M Johnson; Christopher K Bichakjian; Sandra L Wong Journal: Ann Surg Oncol Date: 2016-05-19 Impact factor: 5.344