Five hundred patients with merkel cell carcinoma evaluated at a single institution Journal Article
| Authors: | Fields, R. C.; Busam, K. J.; Chou, J. F.; Panageas, K. S.; Pulitzer, M. P.; Allen, P. J.; Kraus, D. H.; Brady, M. S.; Coit, D. G. |
| Article Title: | Five hundred patients with merkel cell carcinoma evaluated at a single institution |
| Abstract: | Objective: To identify factors associated with survival in Merkel cell carcinoma (MCC). Background: Merkel cell carcinoma is a rare cutaneous neoplasm. Staging and treatment are based on studies, which incompletely characterize the disease. Methods: Review of a prospective database was performed. Overall survival (OS) was estimated by the Kaplan-Meier method. Disease-specific death (DSD) was analyzed by the competing risks method. Factors associated with OS and DSD were determined by the log-rank test and Grays test, respectively. Results: A total of 500 patients with MCC treated at our institution from 1969 to 2010 were identified. Eighty-eight patients presented older than 6 months after diagnosis and were excluded from further analysis. Of the remaining 412 patients, the median age at diagnosis was 71 years. Median follow-up was 3 years. Fifty percent of patients died during follow-up: 25% died of disease, 24% died of other causes. Five-year OS and DSD were 56% and 30%, respectively. Pathologic stage and lymphovascular invasion were independent predictors of DSD. Patients with metastatic disease (stage 4) or clinically positive lymph nodes (stage 3b) had increased DSD compared with patients with microscopically positive (stage 3a) or negative lymph nodes (stage 1 and 2). There was no difference in DSD between stage 3a or 2 compared with stage 1. Importantly, only 1 of 132 patients without lymphovascular invasion died of MCC. Conclusions: OS is a poor measure of the influence of MCC on life expectancy. The presence of lymphovascular invasion and clinically, but not microscopically, positive lymph nodes were associated with increased DSD. These factors should be incorporated into MCC staging and treatment recommendations. © 2011 by Lippincott Williams & Wilkins. |
| Keywords: | adult; cancer chemotherapy; cancer survival; controlled study; treatment outcome; aged; middle aged; cancer surgery; major clinical study; overall survival; microscopy; cisplatin; cancer risk; conference paper; adjuvant therapy; cancer adjuvant therapy; research design; cancer staging; follow up; follow-up studies; lymph node metastasis; cancer diagnosis; neoplasm staging; prospective study; prospective studies; disease association; carboplatin; metastasis; multiple cycle treatment; skin neoplasms; etoposide; antineoplastic combined chemotherapy protocols; camptothecin; risk assessment; irinotecan; cancer invasion; cause of death; clinical evaluation; merkel cell tumor; carcinoma, merkel cell; kaplan meier method; onset age; log rank test; kaplan-meier estimate; lymphovascular invasion; disease specific death; independent variable; infusion pumps; lymph vessel metastasis |
| Journal Title: | Annals of Surgery |
| Volume: | 254 |
| Issue: | 3 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2011-09-01 |
| Start Page: | 465 |
| End Page: | 475 |
| Language: | English |
| DOI: | 10.1097/SLA.0b013e31822c5fc1 |
| PROVIDER: | scopus |
| PUBMED: | 21865945 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 3 October 2011" - "CODEN: ANSUA" - "Source: Scopus" |
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