TY - JOUR
T1 - Relationships among primary tumor size, number of involved nodes, and survival for 8044 cases of Merkel cell carcinoma
AU - Iyer, Jayasri G.
AU - Storer, Barry E.
AU - Paulson, Kelly G.
AU - Lemos, Bianca
AU - Phillips, Jerri Linn
AU - Bichakjian, Christopher K.
AU - Zeitouni, Nathalie
AU - Gershenwald, Jeffrey E.
AU - Sondak, Vernon
AU - Otley, Clark C.
AU - Yu, Siegrid S.
AU - Johnson, Timothy M.
AU - Liegeois, Nanette J.
AU - Byrd, David
AU - Sober, Arthur
AU - Nghiem, Paul
N1 - Funding Information:
Supported by National Institutes of Health (NIH) K02-AR50993 , American Cancer Society RSG-08-115-01-CCE , NIH K24-CA139052 , the David and Rosalind Bloom Endowment for Merkel Cell Carcinoma Research , the Michael Piepkorn Endowment , and the University of Washington Merkel Cell Carcinoma Patient Gift Fund .
PY - 2014/4
Y1 - 2014/4
N2 - Background: The effects of primary tumor size on nodal involvement and of number of involved nodes on survival have not, to our knowledge, been examined in a national database of Merkel cell carcinoma (MCC). Objective: We sought to analyze a retrospective cohort of patients with MCC from the largest US national database to assess the relationships between these clinical parameters and survival. Methods: A total of 8044 MCC cases in the National Cancer Data Base were analyzed. Results: There was a 14% risk of regional nodal involvement for 0.5-cm tumors that increased to 25% for 1.7-cm (median-sized) tumors and to more than 36% for tumors 6 cm or larger. The number of involved nodes was strongly predictive of survival (0 nodes, 76% 5-year relative survival; 1 node, 50%; 2 nodes, 47%; 3-5 nodes, 42%; and ≥6 nodes, 24%; P < .0001 for trend). Younger and/or male patients were more likely to undergo pathological nodal evaluation. Limitations: The National Cancer Data Base does not capture disease-specific survival. Hence, relative survival was calculated by comparing overall survival with age- and sex-matched US population data. Conclusion: Pathologic nodal evaluation should be considered even for patients with small primary MCC tumors. The number of involved nodes is strongly predictive of survival and may help improve prognostic accuracy and management.
AB - Background: The effects of primary tumor size on nodal involvement and of number of involved nodes on survival have not, to our knowledge, been examined in a national database of Merkel cell carcinoma (MCC). Objective: We sought to analyze a retrospective cohort of patients with MCC from the largest US national database to assess the relationships between these clinical parameters and survival. Methods: A total of 8044 MCC cases in the National Cancer Data Base were analyzed. Results: There was a 14% risk of regional nodal involvement for 0.5-cm tumors that increased to 25% for 1.7-cm (median-sized) tumors and to more than 36% for tumors 6 cm or larger. The number of involved nodes was strongly predictive of survival (0 nodes, 76% 5-year relative survival; 1 node, 50%; 2 nodes, 47%; 3-5 nodes, 42%; and ≥6 nodes, 24%; P < .0001 for trend). Younger and/or male patients were more likely to undergo pathological nodal evaluation. Limitations: The National Cancer Data Base does not capture disease-specific survival. Hence, relative survival was calculated by comparing overall survival with age- and sex-matched US population data. Conclusion: Pathologic nodal evaluation should be considered even for patients with small primary MCC tumors. The number of involved nodes is strongly predictive of survival and may help improve prognostic accuracy and management.
KW - Merkel cell carcinoma
KW - National Cancer Data Base
KW - average tumor size
KW - neuroendocrine carcinoma of the skin
KW - nodal spread
KW - prognosis
KW - regional node metastasis
KW - sentinel lymph node biopsy
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U2 - 10.1016/j.jaad.2013.11.031
DO - 10.1016/j.jaad.2013.11.031
M3 - Article
C2 - 24521828
AN - SCOPUS:84896084418
SN - 0190-9622
VL - 70
SP - 637
EP - 643
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 4
ER -