Sarah T Arron1, Theresa Canavan1, Siegrid S Yu2. 1. Department of Dermatology, University of California, San Francisco, California. 2. Department of Dermatology, University of California, San Francisco, California. Electronic address: yus@derm.ucsf.edu.
Abstract
BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Immunosuppression is associated with increased incidence of MCC. OBJECTIVE: We sought to determine whether solid organ transplant recipients (SOTR) with MCC had decreased progression-free, disease-specific, and overall survival compared with immunocompetent patients. METHODS: We conducted a retrospective cohort study examining 8 SOTR with MCC and 89 immunocompetent control subjects. Cox regression models were generated for outcomes of progression, disease-specific death, and death from any cause, adjusted for patient sex, age at diagnosis, and stage at presentation. RESULTS: SOTR had a 4.1-fold increased hazard for progression (95% confidence interval 1.57-10.95, P=.004), a 10.5-fold increased hazard for all-cause mortality (95% confidence interval 3.06-35.98, P<.0001), and an 11.9-fold increased hazard for MCC-specific death (95% confidence interval 2.67-53.08, P=.001), adjusted for sex, age, and stage at presentation. SOTR had decreased 1-year overall survival, 46.8% versus 88.6%, and decreased 1-year MCC-specific survival, 56.3% versus 95.2%. LIMITATIONS: This is a single-center study from a tertiary academic care center, and may not be generalizable to all patient populations. CONCLUSIONS: SOTR have a significant reduction in overall, MCC-specific, and progression-free survival compared with immunocompetent patients. Further studies will determine whether aggressive treatment may improve outcomes in this high-risk population.
BACKGROUND:Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Immunosuppression is associated with increased incidence of MCC. OBJECTIVE: We sought to determine whether solid organ transplant recipients (SOTR) with MCC had decreased progression-free, disease-specific, and overall survival compared with immunocompetent patients. METHODS: We conducted a retrospective cohort study examining 8 SOTR with MCC and 89 immunocompetent control subjects. Cox regression models were generated for outcomes of progression, disease-specific death, and death from any cause, adjusted for patient sex, age at diagnosis, and stage at presentation. RESULTS: SOTR had a 4.1-fold increased hazard for progression (95% confidence interval 1.57-10.95, P=.004), a 10.5-fold increased hazard for all-cause mortality (95% confidence interval 3.06-35.98, P<.0001), and an 11.9-fold increased hazard for MCC-specific death (95% confidence interval 2.67-53.08, P=.001), adjusted for sex, age, and stage at presentation. SOTR had decreased 1-year overall survival, 46.8% versus 88.6%, and decreased 1-year MCC-specific survival, 56.3% versus 95.2%. LIMITATIONS: This is a single-center study from a tertiary academic care center, and may not be generalizable to all patient populations. CONCLUSIONS: SOTR have a significant reduction in overall, MCC-specific, and progression-free survival compared with immunocompetent patients. Further studies will determine whether aggressive treatment may improve outcomes in this high-risk population.
Authors: Christopher K Bichakjian; Thomas Olencki; Sumaira Z Aasi; Murad Alam; James S Andersen; Rachel Blitzblau; Glen M Bowen; Carlo M Contreras; Gregory A Daniels; Roy Decker; Jeffrey M Farma; Kris Fisher; Brian Gastman; Karthik Ghosh; Roy C Grekin; Kenneth Grossman; Alan L Ho; Karl D Lewis; Manisha Loss; Daniel D Lydiatt; Jane Messina; Kishwer S Nehal; Paul Nghiem; Igor Puzanov; Chrysalyne D Schmults; Ashok R Shaha; Valencia Thomas; Yaohui G Xu; John A Zic; Karin G Hoffmann; Anita M Engh Journal: J Natl Compr Canc Netw Date: 2018-06 Impact factor: 12.693