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. 2020 Sep;122(4):653-659.
doi: 10.1002/jso.26048. Epub 2020 Jun 20.

Decreased survival and increased recurrence in Merkel cell carcinoma significantly linked with immunosuppression

Mary K Bryant  1 , Christine Ward  2 , Charles E Gaber  3 , Paula D Strassle  3 , David W Ollila  1 , Shachar Laks  4
Affiliations

Decreased survival and increased recurrence in Merkel cell carcinoma significantly linked with immunosuppression

Mary K Bryant et al. J Surg Oncol. 2020 Sep.

Abstract

Background: Merkel cell carcinoma (MCC) is a rare and aggressive form of skin cancer. It is an immunogenic tumor as evident by its association with Polyomavirus, immunotherapy response, and increased prevalence in the immunosuppressed population.

Objective: We sought to evaluate the impact of known clinicopathological determinants and immunosuppression on the risk of recurrence and mortality of MCC patients.

Methods: A retrospective, observational cohort study of patients diagnosed and/or treated with MCC at two tertiary academic institutions. We compared clinicopathological determinants, treatment modalities, and immunosuppression status on clinical outcomes of recurrence, disease-specific survival, and overall survival.

Results: We evaluated 90 patients within our study and 34% had a cancer recurrence during follow-up. Patients with recurrence were significantly more likely to be immunosuppressed (32% vs 5%; P = .001). Estimated 5-year recurrence was 43%, and immunosuppressed patients were significantly more likely to recur (Hazard ratio [HR] 3.67 [1.80-7.51]; P < .0001). Immunosuppressed patients had significantly elevated cancer-specific mortality (HR 6.11[1.61-23.26]; P = .008).

Limitations: Retrospective review with a prolonged observation period and changing treatment modalities.

Conclusion: Immunocompromised patients had a threefold increased incidence of 5-year mortality and over twofold increased incidence of any recurrence as non-immunocompromised patients. Patients' immunosuppressive status should be considered when making decisions regarding treatment, surveillance, and prognostication.

Keywords: Merkel cell carcinoma; immunosuppression; prognosis.

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References

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