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. 2021 Jan;28(1):519-529.
doi: 10.1245/s10434-020-08587-3. Epub 2020 May 13.

Patterns of Metastasis in Merkel Cell Carcinoma

Yun Song  1 , Feredun S Azari  2 , Rebecca Tang  2 , Adrienne B Shannon  2 , John T Miura  2 , Douglas L Fraker  2 , Giorgos C Karakousis  2
Affiliations

Patterns of Metastasis in Merkel Cell Carcinoma

Yun Song et al. Ann Surg Oncol. 2021 Jan.

Abstract

Background: Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine malignancy with a propensity for regional and distant spread. Because of the relative infrequency of this disease, the patterns of metastasis in MCC are understudied.

Methods: Patients with American Joint Committee on Cancer (8th edition) stage I-IV MCC treated at our institution were identified (1/1/2008-2/28/2018). The first site of metastasis was classified as regional [regional lymph node (LN) basin, in-transit] or distant. Distant metastasis-free (DMFS) and MCC-specific (MSS) survival were estimated.

Results: Of 133 patients, 64 (48%) had stage I, 13 (10%) stage II, 48 (36%) stage III, and 8 (6%) stage IV disease at presentation. The median follow-up time in patients who remained alive was 36 (interquartile range 20-66) months. Regional or distant metastases developed in 78 (59%) patients. The first site was regional in 87%, including 73% with isolated LN involvement, and distant in 13%. Thirty-seven (28%) patients eventually developed distant disease, which most commonly involved the abdominal viscera (51%) and distant LNs (46%) first. The lung (0%) and brain (3%) were rarely the first distant sites. Stage III MCC at presentation was significantly associated with worse DMFS (hazard ratio 4.87, P = 0.001) and stage IV disease with worse MSS (hazard ratio 6.30, P = 0.002).

Conclusions: Regional LN metastasis is the most common first metastatic event in MCC, confirming the importance of nodal evaluation. Distant disease spread appears to have a predilection for certain sites. Understanding these patterns could help to guide surveillance strategies.

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Conflict of interest statement

The authors declare no relevant conflict of interest.

Figures

Fig. 1
Fig. 1
First site of metastasis among 78 patients who developed regional or distant metastases. LN lymph node
Fig. 2
Fig. 2
First site(s) of distant metastasis among 37 patients who developed distant disease. LN lymph node. Percentages do not add up to 100% as patients may have had multiple sites involved
Fig. 3
Fig. 3
Kaplan–Meier estimates of distant metastasis-free survival of 125 patients who presented with American Joint Committee on Cancer (AJCC) stage I through III Merkel cell carcinoma
Fig. 4
Fig. 4
Kaplan–Meier estimates of Merkel cell-specific survival
See this image and copyright information in PMC

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