Journal
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Volume 70, Issue 4, Pages 637-643Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaad.2013.11.031
Keywords
average tumor size; Merkel cell carcinoma; National Cancer Data Base; neuroendocrine carcinoma of the skin; nodal spread; prognosis; regional node metastasis; sentinel lymph node biopsy
Categories
Funding
- National Institutes of Health (NIH) [K02-AR50993]
- American Cancer Society [RSG-08-115-01-CCE]
- NIH [K24-CA139052]
- David and Rosalind Bloom Endowment for Merkel Cell Carcinoma Research
- Michael Piepkorn Endowment
- University of Washington
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Background: The effects of primary tumor size on nodal involvement and of number of involved nodes on survival have not, to our knowledge, been examined in a national database of Merkel cell carcinoma (MCC). Objective: We sought to analyze a retrospective cohort of patients with MCC from the largest US national database to assess the relationships between these clinical parameters and survival. Methods: A total of 8044 MCC cases in the National Cancer Data Base were analyzed. Results: There was a 14% risk of regional nodal involvement for 0.5-cm tumors that increased to 25% for 1.7-cm (median-sized) tumors and to more than 36% for tumors 6 cm or larger. The number of involved nodes was strongly predictive of survival (0 nodes, 76% 5-year relative survival; 1 node, 50%; 2 nodes, 47%; 3-5 nodes, 42%; and >= 6 nodes, 24%; P<.0001 for trend). Younger and/or male patients were more likely to undergo pathological nodal evaluation. Limitations: The National Cancer Data Base does not capture disease-specific survival. Hence, relative survival was calculated by comparing overall survival with age-and sex-matched US population data. Conclusion: Pathologic nodal evaluation should be considered even for patients with small primary MCC tumors. The number of involved nodes is strongly predictive of survival and may help improve prognostic accuracy and management.
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