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A machine-learning modified CART algorithm informs Merkel cell carcinoma prognosis.

Shayan Cheraghlou1, Praneeth Sadda2,3, George O Agogo4

  • 1Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA.

The Australasian Journal of Dermatology
|May 24, 2021
PubMed
Summary
This summary is machine-generated.

Merkel cell carcinoma (MCC) staging can be improved by incorporating the number of positive lymph nodes. This new risk stratification is more predictive of survival than current methods for this rare skin cancer.

Keywords:
CARTMerkel cell carcinomaNCDBSEERmachine-learningstaging

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Area of Science:

  • Oncology
  • Dermatology
  • Biostatistics

Background:

  • Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer with high mortality.
  • Current MCC staging relies on tumor size, lymph node metastasis detection, biopsy, and distant metastasis presence.

Purpose of the Study:

  • To develop a novel prognostic model for MCC using a modified classification and regression tree (CART) algorithm.
  • To identify new prognostic factors beyond current staging criteria using the National Cancer Database (NCDB).

Main Methods:

  • Retrospective cohort study utilizing NCDB and Surveillance, Epidemiology, and End Results (SEER) registries.
  • A modified CART algorithm was developed on a training cohort and validated on separate NCDB and SEER cohorts.
  • Prognostic groups were identified based on tumor variables and lymph node status.

Main Results:

  • A modified CART algorithm defined four prognostic strata: local disease, ≤3 positive nodes, ≥4 positive nodes, and distant metastases.
  • Three-year survival rates varied significantly across strata (81.2% to 20.2%) in the validation cohort.
  • The novel strata demonstrated superior within-group homogeneity and survival prediction compared to AJCC staging groups.

Conclusions:

  • Risk-stratified grouping incorporating positive lymph node count is highly predictive of MCC survival.
  • This approach offers improved within-group homogeneity and survival prediction compared to existing staging.
  • Integrating positive lymph node count into MCC staging could enhance future staging criteria.