Gender and immunosuppression impact on Merkel cell carcinoma diagnosis and prognosis. A population based cohort study

Abstract

Background Merkel cell carcinoma (MCC), a rare cutaneous neuroendocrine endocrine tumour is increasing in incidence, and continues to carry a poor prognosis. Objectives The objectives of this study were to examine all Irish cases of MCC from 1 January 1994 over 2 decades, focusing on gender and organ transplantation recipients (OTRs). Cases were identified from the National Cancer Registry of Ireland. Covariates of interest included age, body site, period of diagnosis, deprivation‐status and history of non‐melanoma skin cancer (NMSC). Results In total 314 MCC cases were identified. A female predominance was noted (53.8%). Comparison between age‐standardised rates between the earliest period (1994–1996) with the latest period (2012–2014) showed an increase of 105% in total. The trend in age‐standardised incidence rates were noted to be increasing significantly (p = 0.0004). Average age at diagnosis was 77.6 years (male 75.1 years, female 79.7 years). Overall, the majority of MCC cases presented on the head and neck (n = 170, 54.1%). Differences in anatomical location of MCCs were noted between genders. Males were found to be more likely to have a history of previous NMSCs (males n = 73 [57.9%], females n = 53 [42.1%]). Thirty‐one percentage of patients died from MCC, average survival was 3.5 years in those who died of this malignancy. Ten organ transplant recipients developed MCC. OTR who developed MCC were diagnosed at a younger average age of 65.1 years. Standardized incidence ratio for MCC in OTR was 59.96. A higher proportion of OTR died from MCC (70%), with a shorter median survival of 0.14 years. In competing risks regression, gender was not significantly associated with risk of dying, females having a non‐significantly higher hazard of dying. Organ transplant recipients and patients from less deprived areas were at greater risk of dying from MCC. Conclusions This population based study provides epidemiological, clinical and outcome data for MCC over a 20‐year period.

Comparison of Prognostic Factors for Merkel Cell Carcinoma, Mucosal Melanoma and Cutaneous Malignant Melanoma: Insights into Their Etiologies

“…We observed higher rates of both CMM and MCC in males. Another study also reported this sex difference and found that MCC and CMM are distributed across similar body sites [ 39 ].…”

Multidisciplinary Treatment of Merkel Cell Carcinoma of the Extremities: Outcomes and Factors Associated with Poor Survival in Nodal Disease

“…In our series, there was no difference in recurrence or survival between those who underwent radiation or LND. While the sample size of patients undergoing LND was certainly limited by our institution's preference towards regional radiation, several prior studies were also unable to detect a difference between adjuvant RT and LND [12][13][14]. On the other hand, a more recent database study of 447 patients with MCC and positive node biopsy found that LND alone was associated with worse overall survival compared with adjuvant RT alone or RT plus LND [15].…”

Epidemiology of Merkel Cell Polyomavirus Infection and Merkel Cell Carcinoma

“…In the US, the incidence was higher in men (1.03, 61.5% of new cases) than in women (0.45, 38.5% of new cases), which has also been observed in most studies worldwide [ 56 , 57 ]. As an exception, a female predominance (53.8% of new cases) was observed in Ireland [ 58 ]. The incidence rates determined in different studies from countries all over the world are summarized in Table 1 .…”

“…In the normal population, the median age at diagnosis was 77.6 years. In contrast, OTR who developed MCC were diagnosed at a younger median age of 65.1 years, and the SIR for MCC (59.96) was very high [ 58 ].…”

“…Consequently, solid-organ transplantation was associated with an increased cumulative incidence of progression (standard hazard ratio (SHR): 3.35), MCC-specific mortality (SHR: 2.55), and overall mortality (HR: 3.26) [ 102 ]. In another study, a high proportion (70%) of OTR died from MCC, and the median survival was only 0.14 years [ 58 ].…”