The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA.
NYU Dermatologic Surgical Associates, 222 East 41st Street, New York, NY, 10017, USA.
Arch Dermatol Res. 2024 Feb 13;316(3):86. doi: 10.1007/s00403-024-02817-4.
Merkel cell carcinoma (MCC) is a neuroendocrine skin cancer with a high rate of mortality. While still relatively rare, the incidence of MCC has been rapidly rising in the US and around the world. Since 2017, two immunotherapeutic drugs, avelumab and pembrolizumab, have been FDA-approved for the treatment of metastatic MCC and have revolutionized outcomes for MCC. However, real-world outcomes can differ from clinical trial data, and the adoption of novel therapeutics can be gradual. We aimed to characterize the treatment practices and outcomes of patients with metastatic MCC across the US. A retrospective cohort study of adult cases of MCC in the National Cancer Database diagnosed from 2004 to 2019 was performed. Multivariable logistic regressions to determine the association of a variety of patient, tumor, and system factors with likelihood of receipt of systemic therapies were performed. Univariate Kaplan-Meier and multivariable Cox survival regressions were performed. We identified 1017 cases of metastatic MCC. From 2017 to 2019, 54.2% of patients received immunotherapy. This increased from 45.1% in 2017 to 63.0% in 2019. High-volume centers were significantly more likely to use immunotherapy (odds ratio 3.235, p = 0.002). On univariate analysis, patients receiving systemic immunotherapy had significantly improved overall survival (p < 0.001). One-, 3-, and 5-year survival was 47.2% (standard error [SE] 1.8%), 21.8% (SE 1.5%), and 16.5% (SE 1.4%), respectively, for patients who did not receive immunotherapy versus 62.7% (SE 3.5%), 34.4% (SE 3.9%), and 23.6% (SE 4.4%), respectively, for those who did (Fig. 1). In our multivariable survival regression, receipt of immunotherapy was associated with an approximately 35% reduction in hazard of death (hazard ratio 0.665, p < 0.001; 95% CI 0.548-0.808). Our results demonstrate that the real-world survival advantage of immunotherapy for metastatic MCC is similar to clinical trial data. However, many patients with metastatic disease did not receive this guideline-recommended therapy in our most recent study year, and use of immunotherapy is higher at high-volume centers. This suggests that regionalization of care to high-volume centers or dissemination of their practices, may ultimately improve patient survival.
默克尔细胞癌（Merkel cell carcinoma，MCC）是一种具有高死亡率的神经内分泌皮肤癌。虽然仍然相对罕见，但 MCC 的发病率在美国和世界各地都在迅速上升。自 2017 年以来，两种免疫治疗药物avelumab 和 pembrolizumab 已获得 FDA 批准用于治疗转移性 MCC，并彻底改变了 MCC 的治疗结果。然而，实际结果可能与临床试验数据有所不同，新疗法的采用可能是渐进的。我们旨在描述美国转移性 MCC 患者的治疗实践和结果。我们对 2004 年至 2019 年国家癌症数据库中诊断为 MCC 的成年病例进行了回顾性队列研究。进行多变量逻辑回归以确定各种患者、肿瘤和系统因素与接受系统治疗的可能性之间的关联。进行了单变量 Kaplan-Meier 和多变量 Cox 生存回归。我们确定了 1017 例转移性 MCC 病例。从 2017 年到 2019 年，54.2%的患者接受了免疫治疗。这一比例从 2017 年的 45.1%增加到 2019 年的 63.0%。高容量中心更有可能使用免疫疗法（优势比 3.235，p=0.002）。在单变量分析中，接受系统免疫治疗的患者总生存显著改善（p<0.001）。未接受免疫治疗的患者的 1 年、3 年和 5 年生存率分别为 47.2%（标准误差 [SE] 1.8%）、21.8%（SE 1.5%）和 16.5%（SE 1.4%），而接受免疫治疗的患者分别为 62.7%（SE 3.5%）、34.4%（SE 3.9%）和 23.6%（SE 4.4%）（图 1）。在我们的多变量生存回归中，接受免疫治疗与死亡风险降低约 35%相关（风险比 0.665，p<0.001；95%CI 0.548-0.808）。我们的结果表明，免疫治疗转移性 MCC 的实际生存优势与临床试验数据相似。然而，在我们最近的研究年份中，许多患有转移性疾病的患者并未接受这种指南推荐的治疗，而且在高容量中心使用免疫疗法的比例更高。这表明将护理区域化到高容量中心或传播其实践可能最终会提高患者的生存率。
