Single-institution series of early-stage merkel cell carcinoma: Long-term outcomes in 95 patients managed with surgery alone

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Abstract

Aim: To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone. Methods: Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n = 42) or staged with sentinel lymph node biopsy (n = 21), and clinically positive nodes underwent lymph node dissection (n = 32). Results: Median follow-up was 65 months. A total of 45 (47%) patients relapsed, with 80% of the recurrences occurring within 2 years and 96% within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52% and 67%, respectively. CCI of local 5-year recurrence was 5% for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19%, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2% (P = 0.007). Comparing patients with ≤ 2 versus > 2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0% versus 39% (P = 0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37% versus 12%; P = 0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22%, and patients with occult primary had a 5-year distant-recurrence CCI of 49% (P = 0.023). The 5-year DSS rate was 80% for pathologically node-negative patients. Conclusion: The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.

Original languageEnglish
Pages (from-to)2985-2993
Number of pages9
JournalAnnals of Surgical Oncology
Volume16
Issue number11
DOIs
Publication statusPublished - Nov 2009

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Merkel Cell Carcinoma
Recurrence
Incidence
Neck
Extremities
Head
Sentinel Lymph Node Biopsy
Lymph Node Excision

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

@article{e6cd6e59f1314ede9b5e19d679e32e11,
title = "Single-institution series of early-stage merkel cell carcinoma: Long-term outcomes in 95 patients managed with surgery alone",
abstract = "Aim: To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone. Methods: Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n = 42) or staged with sentinel lymph node biopsy (n = 21), and clinically positive nodes underwent lymph node dissection (n = 32). Results: Median follow-up was 65 months. A total of 45 (47{\%}) patients relapsed, with 80{\%} of the recurrences occurring within 2 years and 96{\%} within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52{\%} and 67{\%}, respectively. CCI of local 5-year recurrence was 5{\%} for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19{\%}, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2{\%} (P = 0.007). Comparing patients with ≤ 2 versus > 2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0{\%} versus 39{\%} (P = 0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37{\%} versus 12{\%}; P = 0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22{\%}, and patients with occult primary had a 5-year distant-recurrence CCI of 49{\%} (P = 0.023). The 5-year DSS rate was 80{\%} for pathologically node-negative patients. Conclusion: The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.",
author = "Emilio Bajetta and Luigi Celio and Marco Platania and {Lo Vullo}, Salvatore and Roberto Patuzzo and Andrea Maurichi and Mario Santinami",
year = "2009",
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volume = "16",
pages = "2985--2993",
journal = "Annals of Surgical Oncology",
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TY - JOUR

T1 - Single-institution series of early-stage merkel cell carcinoma

T2 - Long-term outcomes in 95 patients managed with surgery alone

AU - Bajetta, Emilio

AU - Celio, Luigi

AU - Platania, Marco

AU - Lo Vullo, Salvatore

AU - Patuzzo, Roberto

AU - Maurichi, Andrea

AU - Santinami, Mario

PY - 2009/11

Y1 - 2009/11

N2 - Aim: To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone. Methods: Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n = 42) or staged with sentinel lymph node biopsy (n = 21), and clinically positive nodes underwent lymph node dissection (n = 32). Results: Median follow-up was 65 months. A total of 45 (47%) patients relapsed, with 80% of the recurrences occurring within 2 years and 96% within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52% and 67%, respectively. CCI of local 5-year recurrence was 5% for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19%, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2% (P = 0.007). Comparing patients with ≤ 2 versus > 2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0% versus 39% (P = 0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37% versus 12%; P = 0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22%, and patients with occult primary had a 5-year distant-recurrence CCI of 49% (P = 0.023). The 5-year DSS rate was 80% for pathologically node-negative patients. Conclusion: The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.

AB - Aim: To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone. Methods: Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n = 42) or staged with sentinel lymph node biopsy (n = 21), and clinically positive nodes underwent lymph node dissection (n = 32). Results: Median follow-up was 65 months. A total of 45 (47%) patients relapsed, with 80% of the recurrences occurring within 2 years and 96% within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52% and 67%, respectively. CCI of local 5-year recurrence was 5% for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19%, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2% (P = 0.007). Comparing patients with ≤ 2 versus > 2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0% versus 39% (P = 0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37% versus 12%; P = 0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22%, and patients with occult primary had a 5-year distant-recurrence CCI of 49% (P = 0.023). The 5-year DSS rate was 80% for pathologically node-negative patients. Conclusion: The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.

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