Understanding the influence of patient demographics on disease severity, treatment strategy, and survival outcomes in merkel cell carcinoma: a surveillance, epidemiology, and end-results study

Abstract

ObjectiveTo identify trends in patient presentation and outcomes data that may guide the development of clinical algorithms on Merkel Cell Carcinoma (MCC).MethodsWe performed a retrospective cohort study searching in the National Cancer Institute's SEER registry for documented MCC cases from 1986-2013. No exclusion criteria were applied. We hereby identified 7,831 original MCC entries. Demographics, staging, and socioeconomic characteristics were identified and treatment modality likelihoods and survival data were calculated via logistic regression and Kaplan-Meier statistical modeling.ResultsConcerning tumor localization, 44.5% (n= 3,485) were located on the head and neck, and 47.8% were located on the trunk and extremities (n= 3,742). Male and younger patients are more likely to receive radiation than surgery with no differences seen among patient race. Caucasians and “Other” races both showed higher overall survival than African American patients. States with higher median household income levels demonstrated survival advantage. Income quartiles yielded no differences in surgical or radiotherapy interventions. Moreover, patients who forego radiotherapy had a poorer overall survival.LimitationsGeneralizability of SEER data, potential intrinsic coding inconsistencies, and limited information on patient comorbidities, sentinel lymph node and surgical margin status are major limitations. There is no information regarding medical intervention such as systemic chemotherapy or immunotherapy. Recoding efforts are inconclusive regarding variables such as tumor infiltrating lymphocytes, mutations, or immunosuppression status, which are well-documented for other cancers within the database.ConclusionMCC lesions of the head and neck region, lower income quartiles, and African American race are associated with higher mortality. MCC patients have a median household income that is significantly higher than national values with no significant difference in subsequent treatment modalities (surgery or radiotherapy) based on socioeconomic markers. A lack of radiotherapy is associated with higher mortality.

Merkel Cell Carcinoma Treatment in Finland in 1986–2016—A Real-World Data Study

“…Despite our best efforts, this finding remains unexplained. Otherwise, our patient cohort is similar to that of previously published large series, with a mean age of 78 years at time of diagnosis, 60% of tumours located in the head and neck region and localized stage of disease [11,16,17,25].…”

“…We found that the frequency of any RT given to MCC patients in Finland increased from less than 1% to over 5% after 2005. Compared with the SEER-based results from the United States, where nearly half of the MCC patients were treated with RT [11,34], utilizing RT in MCC treatment is still less common in Finland. Relative to the years 1986-2005, there were no advances in disease-specific survival of MCC patients after 2005, despite the advent of SLNB in 2005 (Table 1).…”

“…Aside from MCPyV infection and UV radiation exposure, risk factors for MCC are high age, fair skin and immunosuppression [8]. MCC most often presents in the head and neck region [9][10][11].…”

Burden of Disease, Early Diagnosis, and Treatment of Merkel Cell Carcinoma in Latin America

“… 66 Publications that assess the impact of socioeconomic factors on the management, progression, and survival of MCC have demonstrated lower survival in low-income cities with a low density of dermatology specialists. 67 , 68 A better understanding of the disease by all health care providers, especially clinicians, would likely increase the number of cases diagnosed. Thus, more and better continuing medical education about skin cancer is needed.…”

Management Recommendations for Merkel Cell Carcinoma—A Danish Perspective

“…The incidence in Denmark has increased 5.4-fold from 0.06 cases/100,000 in 1986 to 0.31 cases/100,000 in 2002 [3]. The median age of patients at diagnosis is 77 years, with the majority being male (62%) [4]. MCC is primarily caused by UV-radiation (24%) and/or the presence of MCPyV (76%) [1,5,6].…”