Nomogram prediction for the overall survival and cancer-specific survival of patients diagnosed with Merkel cell carcinoma

Abstract

Background: Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma of the skin, with a high recurrence rate and a high mortality rate worldwide. The purpose of this article is to construct a nomogram that incorporates significant clinical parameters and predicts the survival of individuals with MCC. Methods:The Surveillance, Epidemiology, and End Results (SEER) database was employed to retrospectively analyze all confirmed MCC cases from 2004 to 2015. The data was collected from 3,688 patients, and was randomized as the training or validation group (1:1 ratio). The independent factors which predicted the cancer-specific survival (CSS) and overall survival (OS) for MCC cases were searched for nomogram construction respectively. Independent parameters that affected CSS were determined using the Fine and Gray competing risk regression model. In addition, the time-dependent receiver operating characteristic (ROC) curve was constructed. Then, the area under the curve (AUC) values, calibration curve, and the concordance index (C-index) were used to determine the nomogram performance. At last, decision curve analysis (DCA) was conducted to determine the net clinical benefit. Results:The multivariate analysis results revealed that sex, age, race, marriage, American Joint Committee on Cancer (AJCC) stage, chemotherapy and radiotherapy were independent OS prognostic factors.Furthermore, competing risk analysis showed age, sex, AJCC stage, chemotherapy were the independent CSS prognostic factors. For validation, the C-index value of OS nomogram was 0.703 (95% CI: 0.686-0.721), while C-index value of CSS nomogram was 0.737 (95% CI: 0.710-0.764). Both C-index and AUC suggested that nomograms had superior performance to that of the AJCC stage system. In addition, according to the calibration curve, both nomograms were capable of accurate prediction of MCC prognosis. The DCA showed that the net benefits of the nomograms were superior among various threshold probabilities than these of AJCC stage system. Conclusions:The present work established and verified the novel nomograms to predict the OS and CSS of MCC patients. If further confirmed in future studies, it may become another helpful tool for risk stratification and management of MCC patients.

Postoperative radiotherapy in stage I–III Merkel cell carcinoma

“…[18] Similarly, this phenomenon was demonstrated in a recent analysis, where PORT was identified as a significant contributor to a nomogram for OS, but not to a nomogram for MCC-related survival, again suggesting possible selection bias. [19] Finally, in an analysis of patients with MCC >65 years old, treatment with PORT was found to be associated with improved OS, but not MCC-specific survival. [20] The discrepancy between MCC-related survival and OS in these studies indicate that selection criteria for PORT could be refined, for instance by taking life expectancy into account.…”

Patterns of Care and Data Quality in a National Registry of Black and White Patients with Merkel Cell Carcinoma

“…Black race did not demonstrate significant association in the multivariable analysis performed by Sridharan et al adjusting for sex, patient age and primary tumor site [ 4 ]. Additionally, prior studies have shown OS to be a suboptimal surrogate for cancer-specific survival for patients with MCC [ 21 , 22 , 23 , 24 ]. Optimal consideration of survival for patients with MCC should be evaluated in the context of factors such as immune status [ 14 ], Merkel cell polyomavirus (MCPyV) status, equivalent definitions of race, and competing causes of mortality.…”

Effects of surgery on survival of patients aged 75 years or older with Merkel cell carcinoma

“…Previous studies showed that surgery could not improve outcomes and was not significantly correlated with OS and MSS of MCC patients. 20 , 27 Yan et al compared outcomes of patients undergoing different surgical procedures and reported that different surgical types, including LD, EM ≤1 cm, 1 cm < EM ≤ 2 cm, and EM >2 cm, were not linked with differences in patient prognosis. 19 In the present real‐world clinical study, we observed that surgical resection was associated with improved OS, which is consistent with the results of previous studies regarding the effects of surgery on the outcomes of elderly patients with oral tongue squamous cell carcinoma 21 or pancreatic cancer.…”