Improved survival in women versus men with merkel cell carcinoma

Tam, Moses; Luu, Michael; Barker, Christopher A.; Gharavi, Nima M.; Hamid, Omid; Shiao, Stephen L.; Nguyen, Anthony T.; Lu, D.J.; Ho, Allen S.; Zumsteg, Zachary S.

doi:10.1016/j.jaad.2020.02.034

Cited by 30 publications

(31 citation statements)

References 33 publications

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“…Our findings also show that female patients, regardless of MCPyV status, had a significantly improved OS compared to male patients. This finding is also supported by a recent report from an analysis of a large cohort of MCC cases in the US [ 15 ].…”

Section: Discussionsupporting

confidence: 87%

“…The presence of the virus has since been reported to be a favorable prognostic trait in MCC [ 10 , 11 , 12 ]. 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 ].…”

Section: Introductionmentioning

confidence: 61%

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

Andtback

Björnhagen-Säfwenberg

Shi

et al. 2021

Cancers

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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.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 61%

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

Andtback

Björnhagen-Säfwenberg

Shi

et al. 2021

Cancers

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“…MCC of the head and neck and MCC of the trunk were also significantly associated with increased mortality hazard for patients with stage III MCC in this cohort. Tumor subsite was also associated with OS by multivariable analysis (MVA) in a number of additional NCDB analyses of patients with MCC [4,24]. Specifically for MCC of the head and neck, Smith and colleagues performed an analysis of the Surveillance, Epidemiology, and End Results (SEER) database including 2104 patients with MCC of the head and neck [25] and found MCC of the lip to be associated with worsened diseasespecific survival on MVA relative to MCC of the scalp, face NOS, scalp/neck, eyelid, and external ear [26].…”

Section: Tumor Anatomic Subsitementioning

confidence: 99%

“…Multiple studies have identified more favorable outcomes including improved OS and cancer-specific survival for women with MCC relative to men, adjusting for other relevant baseline patient, tumor, and treatment factors [4,23,24,27]. It has not yet been fully elucidated what potential underlying differences in tumor or host biology may be driving disparate outcomes in MCC by biologic sex.…”

Section: Sexmentioning

confidence: 99%

“…MCC predominantly affects older patients (median age of diagnosis from 75 to 79 years old), with the highest incidence reported in non-Hispanic white patients, with the cutaneous tissue of the head and neck as a common anatomic subsite [ 3 ]. Men are more commonly affected by MCC relative to women, with women showing improved clinical outcomes [ 4 ]. The immune system is believed to play a critical role in MCC pathogenesis with both Merkel cell polyoma virus (MCPyV) and ultraviolet (UV) radiation identified as risk factors for oncogenesis.…”

Section: Introductionmentioning

confidence: 99%

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Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Yusuf

McKenzie

Rattani

et al. 2021

Cancers

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Merkel cell carcinoma (MCC) is a rare, cutaneous neuroendocrine malignancy with increasing incidence. The skin of the head and neck is a common subsite for MCC with distinctions in management from other anatomic areas. Given the rapid pace of developments regarding MCC pathogenesis (Merkel cell polyoma virus (MCPyV)-positive or virus-negative, cell of origin), diagnosis, staging and treatment, and up to date recommendations are critical for optimizing outcomes. This review aims to summarize currently available literature for MCC of the head and neck. The authors reviewed current literature, including international guidelines regarding MCC pathogenesis, epidemiology, diagnosis, staging, and treatment. Subsequently recommendations were derived including the importance of baseline imaging, MCPyV serology testing, primary site surgery, nodal evaluation, radiotherapy, and the increasing role of immune modulating agents in MCC. MCPyV serology testing is increasingly important with potential distinctions in treatment response and surveillance between virus-positive and virus-negative MCC. Surgical management continues to balance optimizing local control with minimal morbidity. Similarly, radiotherapy continues to have importance in the adjuvant, definitive, and palliative setting for MCC of the head and neck. Immunotherapy has changed the paradigm for advanced MCC, with increasing work focusing on optimizing outcomes for non-responders and high-risk patients, including those with immunosuppression.

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Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis

et al. 2022

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IMPORTANCE Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). Stage-specific recurrence data that includes time from diagnosis would provide more precise prognostic information and contribute to risk-appropriate clinical surveillance. OBJECTIVE To estimate risk of stage-specific MCC recurrence and mortality over time since diagnosis. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 618 patients with MCC who were prospectively enrolled in a Seattle-based data repository between 2003 and 2019. Of these patients, 223 experienced a recurrence of MCC. Data analysis was performed July 2019 to November 2021. MAIN OUTCOMES AND MEASURESStage-specific recurrence and survival, as well as cumulative incidence and Kaplan-Meier analyses. RESULTS Among the 618 patients included in the analysis (median [range] age, 69 years; 227 [37%] female), the 5-year recurrence rate for MCC was 40%. Risk of recurrence in the first year was high (11% for patients with pathologic stage I, 33% for pathologic stage IIA/IIB, 30% for pathologic stage IIIA, 45% for pathologic stage IIIB, and 58% for pathologic stage IV), with 95% of recurrences occurring within the first 3 years. Median follow-up among living patients was 4.3 years. Beyond stage, 4 factors were associated with increased recurrence risk in univariable analyses: immunosuppression (hazard ratio [HR], 2.4; 95% CI, 1.7-3.3; P < .001), male sex (HR, 1.9; 95% CI, 1.4-2.5; P < .001), known primary lesion among patients with clinically detectable nodal disease (HR, 2.3; 95% CI, 1.4-4.0; P = .001), and older age (HR, 1.1; 95% CI, 1.0-1.3; P = .06 for each 10-year increase). Among 187 deaths in the cohort, 121 (65%) were due to MCC. The MCC-specific survival rate was strongly stage dependent (95% at 5 years for patients with pathologic stage I vs 41% for pathologic stage IV). Among patients presenting with stage I to II MCC, a local recurrence (17 arising within/adjacent to the primary tumor scar) did not appreciably diminish survival compared with patients who had no recurrence (85% vs 88% MCC-specific survival at 5 years). CONCLUSIONS AND RELEVANCEIn this cohort study, the MCC recurrence rate (approximately 40%) was notably different than that reported for invasive melanoma (approximately 19%), squamous cell carcinoma (approximately 5%-9%), or basal cell carcinoma (approximately 1%-2%) following definitive therapy. Because more than 90% of MCC recurrences arise within 3 years, it is appropriate to adjust surveillance intensity accordingly. Stage-and time-specific recurrence data can assist in appropriately focusing surveillance resources on patients and time intervals in which recurrence risk is highest.

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Improved survival in women versus men with merkel cell carcinoma

Cited by 30 publications

References 33 publications

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

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

Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions

Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis

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