Delisle Megan, Dingley Brittany, Light Anne, Apte Sameer, Mallick Ranjeeta, Hamilton Trevor, Stuart Heather, Talbot Martha, McKinnon Gregory, Jost Evan, Thiboutot Eva, Francescutti Valerie, Samman Salsabila, Easson Alexandra M, Schellenberg Angela, Merchant Shaila, La Julie, Vanderbeck Kaitlin, Wright Frances C, Berger-Richardson David, Hebbard Pamela, Hershorn Olivia, Younan Rami, Patocskai Erica, Rodriguez-Qizilbash Samuel, Meguerditchian Ari, Tchuente Vanina, Kazandjian Suzanne, Mathieson Alex, Hossain Farisa, Hetu Jessika, Johnson-Obaseki Stephanie, Nessim Carolyn
Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
University of Ottawa, Ottawa, ON, Canada.
Ann Surg Oncol. 2025 May 3. doi: 10.1245/s10434-025-17365-y.
The management and survival outcomes of patients with Merkel cell carcinoma (MCC) in Canada are currently unknown. The objective of this study was to investigate the management and outcomes of patients diagnosed with MCC in Canada from 2000 to 2018.
This retrospective cohort study evaluates management and temporal survival differences among patients diagnosed with MCC in ten large urban university centers in three provinces during three periods: 2000-2005, 2006-2011, and 2012-2018.
There were 899 patients included with a median follow-up of 22.8 months. There were no significant changes in patient and tumor characteristics between the three periods. There were increases in the use of radiologic staging (2000-2005, 53.4%; 2006-2011, 73.7%; 2012-2018, 78.1%; p < 0.01), surgery as the sole treatment (2000-2005, 25.7%; 2006-2011, 34.0%; 2012-2018, 31.8%; p = 0.02), and surgery with adjuvant radiation (2000-2005, 37.2%; 2006-2011, 36.2%; 2012-2018, 43.7%; p =0.02) during the study period. Between 2000 and 2018, the 5-year median overall survival (OS) was 47.9% (95% confidence interval (CI) 43.2-55.8%), disease-free survival was (DFS) 48.9% (95% CI 42.4-55.1%), and cancer-specific survival (CSS) was 49.7% (95% CI 43.2-55.8%). There were no significant differences in OS and DFS between the three periods on multivariable analysis. Compared with 2000-2005, there was no significant difference in CSS from 2006 to 2011 (hazard ratio (HR) 1.02 95% CI 0.66-1.62, p = 0.9), but there was a significant improvement in CSS from 2012 to 2018 (HR 0.57 95% CI 0.34-0.97, p = 0.04).
Despite changes in the utilization of staging, surgery, and radiation, the prognosis of patients with MCC in Canada remains poor, highlighting the need for improved management strategies.
目前加拿大默克尔细胞癌（MCC）患者的管理情况及生存结局尚不清楚。本研究的目的是调查2000年至2018年在加拿大被诊断为MCC的患者的管理情况及结局。
这项回顾性队列研究评估了在三个时期（2000 - 2005年、2006 - 2011年和2012 - 2018年），在三个省份的十个大型城市大学中心被诊断为MCC的患者的管理情况及生存时间差异。
共纳入899例患者，中位随访时间为22.8个月。三个时期患者和肿瘤特征无显著变化。在研究期间，放射学分期的使用有所增加（2000 - 2005年为53.4%；2006 - 2011年为73.7%；2012 - 2018年为78.1%；p < 0.01），单纯手术治疗（2000 - 2005年为25.7%；2006 - 2011年为34.0%；2012 - 2018年为31.8%；p = 0.02）以及手术联合辅助放疗（2000 - 2005年为37.2%；2006 - 2011年为36.2%；2012 - 2018年为43.7%；p = 0.02）也有所增加。2000年至2018年，5年中位总生存率（OS）为47.9%（95%置信区间（CI）43.2 - 55.8%），无病生存率（DFS）为48.9%（95% CI 42.4 - 55.1%），癌症特异性生存率（CSS）为49.7%（95% CI 43.2 - 55.8%）。多变量分析显示三个时期的OS和DFS无显著差异。与2000 - 2005年相比，2006年至2011年CSS无显著差异（风险比（HR）1.02，95% CI 0.66 - 1.62，p = 0.9），但2012年至2018年CSS有显著改善（HR 0.57，95% CI 0.34 - 0.97，p = 0.04）。
尽管在分期、手术和放疗的应用方面有所变化，但加拿大MCC患者的预后仍然较差，这突出了改进管理策略的必要性。
