Abstract
PurposeMerkel cell carcinoma (MCC) is a highly malignant cancer associated with dismal survival outcomes. Surgery is the cornerstone for the management of MCC, but the benefit of radiotherapy (RT) and chemotherapy (CT) is still controversial. We aimed to investigate the prognostic value of RT and CT in the management of stage I-III MCC patients using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsPatients with a histopathological diagnosis of MCC between 2010 and 2016 were included. The primary endpoint of this study was overall survival (OS). The prognostic significance for OS was analyzed by Cox proportional hazard regression model.ResultsA total of 1,691 patients were identified in the SEER database. Over half of the patients had received RT (56.7%), and 9.8% of the patients were documented to have received CT. The median OS for the entire cohort was 66.0 months, and the 5-year OS rate was 53.8%. In the multivariate analysis, receiving RT was associated with significantly improved OS (P < 0.001), while receiving CT significantly negatively impacted OS (P = 0.010). In stage III patients who underwent treatment based on surgical resection, RT was still demonstrated to be a positive factor (P = 0.002), while CT had no significant association with OS in the univariate analysis (P = 0.295).ConclusionsThe current data in the SEER database are consistent with earlier studies supporting the benefit of adjuvant RT for stage I-III MCC patients, but caution should be taken regarding the routine use of CT. For stage III MCC patients, the value of adjuvant CT needs to be confirmed in future studies.
Highlights
Merkel cell carcinoma (MCC) is a rare but aggressive form of cancer that was first described in 1972 by Cyril Toker [1]
Based on the result calculated by one hazard ratio (HR) and 95% confidence interval (CI), demonstrated in the dotted, black line, the appropriate inflection point to age at diagnosis was 75 years old
The present study aimed to investigate the influence of demographic, clinical, and treatment factors on the Overall survival (OS) outcomes of MCC patients registered in the SEER database between 2010 and 2016
Summary
Merkel cell carcinoma (MCC) is a rare but aggressive form of cancer that was first described in 1972 by Cyril Toker [1]. Excessive exposure to ultraviolet radiation, Caucasian race and infection with Merkel cell polyomavirus have already been characterized as significant risk factors for the incidence of MCC [2,3,4]. High-level evidence originating from phase III, randomized controlled trials for the management of MCC over the past several decades is still lacking [5]. Local surgery has played a critical role in the management of stage I-III MCC, in accordance with accumulating evidence supporting the sentinel lymph node biopsy (SLNB) procedure for MCC patients who could tolerate surgical excision. Considering the increased incidence of treatmentrelated sequelae, immune suppression and decreased quality of life (QoL), CT is recommended only with caution in indicated high-risk patients based on a clinical assessment
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