Analysis of cutaneous Merkel Cell Carcinoma outcomes after different surgical interventions

Publication date: Available online 5 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Lu Yan, Ledong Sun, Zhiguang Guan, Shanshan Wei, Yanru Wang, Pengfei Li

Background

Current guidelines recommend local excision margin (EM) with 1 to 2cm on primary merkel cell carcinoma (MCC) site.

Objective

We compared survival outcomes of MCC patients treated with different surgical interventions.

Methods

A retrospective analysis of MCC cases in the SEER database was performed by Kaplan-Meier, competing risk and Cox proportional hazards regression model analyses. Influence of age, T stage, AJCC stage, adjuvant radiotherapy and other subgroups were also analyzed by pair-wise log-rank test.

Results

Our results indicated significant association between local destruction method and inferior survival, while EM>2cm showed significantly higher overall survival (OS). In addition, competing risk analysis depicted similar trend as Kaplan-Meier analysis, and considerably reduced estimated cumulative incidence. Further subgroup pair-wise analysis demonstrated that EM>2cm method had better survival in patients younger than 60 years, having smaller tumor diameters (T1 and T2) or undergone adjuvant radiotherapy (p<0.05). In contrast, different EMs did not show any significant association with survival rate in patients older than 75 years or stage III tumors.

Limitations

This study was not prospectively randomized without relapse data.

Conclusions

It is challenging to make optimal EM recommendations, as surgical options may depend on individual case situations. Further prospective randomized studies are warranted.