Jayasri G Iyer1, Barry E Storer2, Kelly G Paulson1, Bianca Lemos3, Jerri Linn Phillips4, Christopher K Bichakjian5, Nathalie Zeitouni6, Jeffrey E Gershenwald7, Vernon Sondak8, Clark C Otley9, Siegrid S Yu10, Timothy M Johnson5, Nanette J Liegeois11, David Byrd12, Arthur Sober13, Paul Nghiem14. 1. Department of Medicine/Dermatology, University of Washington, Seattle, Washington. 2. Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington. 3. Department of Medicine/Dermatology, University of Washington, Seattle, Washington; Department of Dermatology, Emory University, Atlanta, Georgia. 4. Commission on Cancer of the American College of Surgeons, Chicago, Illinois. 5. Department of Dermatology, University of Michigan Health System, Ann Arbor. 6. Roswell Park Cancer Institute, Buffalo, New York. 7. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Taxas. 8. H. Lee Moffitt Cancer Center and Research Institute and the University of South Florida, Tampa, Florida. 9. Department of Dermatology, Mayo Clinic, Rochester. 10. Department of Dermatology, University of California at San Francisco, San Francisco, California. 11. Department of Oncology and Plastic Surgery, Johns Hopkins, Baltimore, Maryland. 12. Department of Surgery, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington. 13. Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. 14. Department of Medicine/Dermatology, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington. Electronic address: pnghiem@uw.edu.
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.
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.
Keywords:
Merkel cell carcinoma; National Cancer Data Base; average tumor size; neuroendocrine carcinoma of the skin; nodal spread; prognosis; regional node metastasis; sentinel lymph node biopsy
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