Sex Differences in Overall Survival and the Effect of Radiotherapy in Merkel Cell Carcinoma-A Retrospective Analysis of a Swedish Cohort.

Hannah Björn Andtback,Hao Shi,Viveca Björnhagen-Säfwenberg,Weng-Onn Lui,Lisa Villabona,Giuseppe V Masucci

doi:10.3390/cancers13020265

Hannah Björn Andtback, Hao Shi + Show 4 more

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https://doi.org/10.3390/cancers13020265

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Journal: Cancers	Publication Date: Jan 12, 2021
Citations: 8	License type: CC BY 4.0

Affiliation: Karolinska University Hospital, Karolinska Institutet

Abstract

Simple SummaryMerkel cell carcinoma (MCC) is a rare and aggressive skin cancer which is believed to be partially caused by a virus or ultraviolet exposure. Most previous studies have shown that MCC is more common in men compared to women, virus associated MCC has a better prognosis and surgery followed by radiotherapy gives a better outcome. In this article, we explore these traits in a Swedish cohort of 113 patients and find that MCC is more common in women and female patients have a longer survival compared to male patients. In addition, we found that virus negative MCC has a worse outcome in male patients and radiotherapy after surgery gives a better outcome for patients who are treated with a curative dosage, irrespective of sex.Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer where Merkel cell Polyomavirus (MCPyV) contributes to the pathogenesis. In an adjuvant setting, radiotherapy (RT) is believed to give a survival benefit. The prognostic impact of sex related to MCPyV-status and adjuvant RT were analyzed in patients referred to Karolinska University Hospital. Data were collected from 113 patients’ hospital records and MCPyV analyses were made in 54 patients (48%). We found a significantly better overall survival (OS) for women compared to men and a significant difference in OS in patients receiving adjuvant RT. Furthermore, we found that men with virus negative MCC have an increased risk for earlier death (HR 3.6). This indicates that MCPyV positive and negative MCC act as two different diseases, and it might be due to different mechanism in the immune response between male and female patients. This could have significance in tailoring treatment and follow-up in MCC patients in the future.

Highlights

Merkel cell carcinoma (MCC) is a rare and highly malignant neuroendocrine skin cancer that mainly affects older people
We reviewed clinical data and outcomes for 113 MCC patients from the Stockholm region who were referred to the Karolinska University Hospital in Stockholm, 3
We reviewed clinical data and outcomes for 113 MCC patients from the Stockholm region who were referred to the Karolinska University Hospital in Stockholm, Sweden

Summary

Introduction

Merkel cell carcinoma (MCC) is a rare and highly malignant neuroendocrine skin cancer that mainly affects older people. The disease mortality in MCC is as high as 46%. The rarity of the disease and its tendency to affect the elderly has contributed to MCC being little studied and the needs for novel prognostic and predictive biomarkers and new treatment regimens are substantial. MCC has in several reports shown a rise in incidence over the last decades [2,5,6,7]. Merkel cell polyomavirus (MCPyV) was discovered in 2008, which was shown to be clonally integrated in the DNA of up to 80% of MCC tumors [8,9]. A trend towards women having a better outcome in MCC has been seen previously [13,14] and a recent finding from a large cohort in the U.S establishes that women do have a better disease specific survival than men [15]

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