Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Surg Oncol. 2022 Aug;126(2):348-355. doi: 10.1002/jso.26861. Epub 2022 Mar 22.
Conditional survival (CS) analysis has emerged as a dynamic prognostication methodology. The goal of this study was to determine disease-specific CS rates in Merkel cell carcinoma (MCC).
This retrospective study included patients with MCC from the Surveillance Epidemiology and End Results (SEER) registry (1988-2016). Stage-specific 5-year MCC-specific CS rates for study and survivor cohorts were estimated, and the significance of clinicopathologic factors to predict 1-year MCC-specific death was evaluated using multivariate logistic regression.
Within stage, 5-year CS survival rates improved with increasing survivorship. Pathologic Stage I patients had the highest 5-year CS rate at diagnosis (89.1%) but the smallest increase over time (96% among 5-year survivors). Stage IV patients experienced the greatest change in 5-year CS rates from 25.4% (at diagnosis) to 88% (5-year survivors). At diagnosis stage, age, sex, and primary site were all significantly associated with 1-year MCC-related death in the multivariate analysis. In contrast, among 5-year survivors only sex and age at diagnosis were significant predictors.
MCC CS rates improved across all disease stages over time. Additionally, the relationships of prognostic factors with 1-year MCC-death changed with increasing survivorship. This perspective can provide a foundation for informed decision-making.
条件生存（CS）分析已成为一种动态预后方法。本研究的目的是确定默克尔细胞癌（MCC）的疾病特异性 CS 率。
本回顾性研究纳入了来自监测、流行病学和最终结果（SEER）登记处（1988-2016 年）的 MCC 患者。估计了研究队列和幸存者队列中各期别 5 年 MCC 特异性 CS 率，并使用多变量逻辑回归评估了临床病理因素对预测 1 年 MCC 特异性死亡的意义。
在各期别内，随着生存时间的延长，5 年 CS 生存率提高。病理 I 期患者在诊断时具有最高的 5 年 CS 率（89.1%），但随时间推移的增加最小（5 年幸存者中为 96%）。IV 期患者的 5 年 CS 率变化最大，从诊断时的 25.4%（诊断时）到 5 年幸存者的 88%。在诊断阶段，年龄、性别和原发部位在多变量分析中均与 1 年 MCC 相关死亡显著相关。相比之下，在 5 年幸存者中，只有性别和诊断时的年龄是显著的预测因素。
随着时间的推移，MCC 的 CS 率在所有疾病阶段均有所提高。此外，预后因素与 1 年 MCC 死亡的关系随着生存时间的延长而发生变化。这种观点可以为知情决策提供基础。
