Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Ann Surg Oncol. 2020 Jun;27(6):1978-1985. doi: 10.1245/s10434-019-08187-w. Epub 2020 Feb 26.
The eighth edition of the American Joint Committee on Cancer (AJCC8) Staging Manual provides important information for staging and prognostication; however, survival estimates for patients with Stage I-III Merkel cell carcinoma (MCC), a rare disease, may be as practical using data from large-volume centers as that collated for the AJCC analysis. As such, we compared our institutional outcomes to AJCC8.
Patients who presented from 2005 to 2017 with MCC to two high-volume centers were included. Demographics, clinicopathologic characteristics, survival and recurrence data were compiled, and outcomes compared to AJCC8.
A total of 409 patients were included. Median age was 75 (range 29-98) years, and 68% were male. Median follow-up was 16 months (0-157). Five-year overall survival (OS) was 70%; 5-year disease-specific survival (DSS) was 84%. When stratified by extent of disease, 5-year OS was higher for patients with local disease compared to those with nodal disease (72.6% vs 62.7%, p=0.005). Similarly, patients with local disease had higher 5-year DSS than those with nodal disease (90.1% vs 76.8%, p=0.002). Five-year recurrence-free survival was 59.2% for all patients, 65.0% for local disease and 48.3% for nodal disease (p=0.033).
Here, MCC patients with local or nodal disease have substantially higher OS rates than predicted in AJCC8 (5-year: 72.6% vs 50.6%; 62.7% vs 35.4%, respectively). Importantly, 5-year DSS was significantly better than the OS rates reported presently and in AJCC8. As clinicians and patients rely on AJCC to accurately prognosticate and guide treatment decisions, these estimates should be reassessed and updated to more accurately predict survival outcomes.
第八版美国癌症联合委员会（AJCC8）分期手册为分期和预后提供了重要信息；然而，对于罕见疾病 Merkel 细胞癌（MCC）的 I-III 期患者，使用大容量中心的数据进行生存估计可能与 AJCC 分析汇总的数据一样实用。因此，我们将我们的机构结果与 AJCC8 进行了比较。
纳入了 2005 年至 2017 年在两个大容量中心就诊的 MCC 患者。收集了患者的人口统计学、临床病理学特征、生存和复发数据，并与 AJCC8 进行了比较。
共纳入 409 例患者。中位年龄为 75 岁（范围 29-98 岁），68%为男性。中位随访时间为 16 个月（0-157）。5 年总生存率（OS）为 70%；5 年疾病特异性生存率（DSS）为 84%。按疾病范围分层，局部疾病患者的 5 年 OS 高于淋巴结疾病患者（72.6%比 62.7%，p=0.005）。同样，局部疾病患者的 5 年 DSS 高于淋巴结疾病患者（90.1%比 76.8%，p=0.002）。所有患者的 5 年无复发生存率为 59.2%，局部疾病患者为 65.0%，淋巴结疾病患者为 48.3%（p=0.033）。
在此，局部或淋巴结疾病的 MCC 患者的 OS 率明显高于 AJCC8 预测的（5 年：72.6%比 50.6%；62.7%比 35.4%）。重要的是，5 年 DSS 明显优于目前和 AJCC8 报告的 OS 率。由于临床医生和患者依赖 AJCC 准确预测预后并指导治疗决策，因此应重新评估和更新这些估计值，以更准确地预测生存结果。
