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Merkel Cell Carcinoma Outcomes: Does AJCC8 Underestimate Survival?

C R Farley1, M C Perez2, S J Soelling3

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Merkel cell carcinoma (MCC) survival rates in Stage I-III patients are higher than AJCC8 predictions. This study suggests reassessing current prognostication for better Merkel cell carcinoma treatment guidance.

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Area of Science:

  • Oncology
  • Cancer Research
  • Epidemiology

Background:

  • The American Joint Committee on Cancer (AJCC) Staging Manual is crucial for cancer prognostication.
  • Merkel cell carcinoma (MCC) is a rare skin cancer with limited large-scale survival data.
  • AJCC8 staging may not fully capture survival nuances for Stage I-III MCC.

Purpose of the Study:

  • To compare institutional outcomes for Merkel cell carcinoma (MCC) patients with AJCC8 staging predictions.
  • To evaluate survival estimates for Stage I-III MCC based on data from high-volume cancer centers.
  • To inform potential revisions of AJCC staging for MCC.

Main Methods:

  • Retrospective analysis of 409 Merkel cell carcinoma (MCC) patients from 2005-2017 at two high-volume centers.
  • Compilation of demographics, clinicopathologic characteristics, survival, and recurrence data.
  • Comparison of institutional outcomes against AJCC8 staging manual predictions.

Main Results:

  • Five-year overall survival (OS) was 70% and disease-specific survival (DSS) was 84% for MCC patients.
  • Patients with local MCC had significantly higher 5-year OS (72.6%) and DSS (90.1%) than those with nodal MCC (62.7% OS, 76.8% DSS).
  • Five-year recurrence-free survival was 59.2% overall, higher for local (65.0%) versus nodal (48.3%) MCC.

Conclusions:

  • Merkel cell carcinoma (MCC) patients with local or nodal disease demonstrate substantially higher overall survival rates than predicted by AJCC8.
  • Five-year disease-specific survival (DSS) for MCC significantly exceeded reported overall survival (OS) rates in AJCC8.
  • Current AJCC8 survival estimates for MCC require reassessment and updating to improve prognostic accuracy for clinicians and patients.