BackgroundMerkel cell carcinoma (MCC) is a rare and aggressive form of skin cancer. It is an immunogenic tumor as evident by its association with Polyomavirus, immunotherapy response, and increased prevalence in the immunosuppressed population.ObjectiveWe sought to evaluate the impact of known clinicopathological determinants and immunosuppression on the risk of recurrence and mortality of MCC patients.MethodsA retrospective, observational cohort study of patients diagnosed and/or treated with MCC at two tertiary academic institutions. We compared clinicopathological determinants, treatment modalities, and immunosuppression status on clinical outcomes of recurrence, disease‐specific survival, and overall survival.ResultsWe evaluated 90 patients within our study and 34% had a cancer recurrence during follow‐up. Patients with recurrence were significantly more likely to be immunosuppressed (32% vs 5%; P = .001). Estimated 5‐year recurrence was 43%, and immunosuppressed patients were significantly more likely to recur (Hazard ratio [HR] 3.67 [1.80‐7.51]; P < .0001). Immunosuppressed patients had significantly elevated cancer‐specific mortality (HR 6.11[1.61‐23.26]; P = .008).LimitationsRetrospective review with a prolonged observation period and changing treatment modalities.ConclusionImmunocompromised patients had a threefold increased incidence of 5‐year mortality and over twofold increased incidence of any recurrence as non–immunocompromised patients. Patients’ immunosuppressive status should be considered when making decisions regarding treatment, surveillance, and prognostication.
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