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. 2021 Jan 12;13(2):265.
doi: 10.3390/cancers13020265.

Sex Differences in Overall Survival and the Effect of Radiotherapy in Merkel Cell Carcinoma-A Retrospective Analysis of a Swedish Cohort

Hannah Björn Andtback  1 , Viveca Björnhagen-Säfwenberg  2 , Hao Shi  1 , Weng-Onn Lui  1 , Giuseppe V Masucci  1 , Lisa Villabona  1
Affiliations

Sex Differences in Overall Survival and the Effect of Radiotherapy in Merkel Cell Carcinoma-A Retrospective Analysis of a Swedish Cohort

Hannah Björn Andtback et al. Cancers (Basel). .

Abstract

Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer where Merkel cell Polyomavirus (MCPyV) contributes to the pathogenesis. In an adjuvant setting, radiotherapy (RT) is believed to give a survival benefit. The prognostic impact of sex related to MCPyV-status and adjuvant RT were analyzed in patients referred to Karolinska University Hospital. Data were collected from 113 patients' hospital records and MCPyV analyses were made in 54 patients (48%). We found a significantly better overall survival (OS) for women compared to men and a significant difference in OS in patients receiving adjuvant RT. Furthermore, we found that men with virus negative MCC have an increased risk for earlier death (HR 3.6). This indicates that MCPyV positive and negative MCC act as two different diseases, and it might be due to different mechanism in the immune response between male and female patients. This could have significance in tailoring treatment and follow-up in MCC patients in the future.

Keywords: merkel cell carcinoma; merkel cell polyoma virus; radiotherapy; sex.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overall survival analysis in relation to gender and age. Kaplan–Meier plots illustrating overall survival (OS) in: (a) the entire cohort; (b) Female (black) vs. Male (red) p = 0.04; and (c) age groups 19–69 years (black) vs. >70 years (red) p = 0.005.
Figure 2
Figure 2
Overall survival analysis in male patients in relation to MCPyV status. Kaplan–Meier plots illustrating overall survival (OS) in (a) male and in (b) female patients with MCPyV-positive (black) or MCPyV-negative (red) tumor tissue, p = 0.001.
Figure 3
Figure 3
Overall survival in patients receiving surgery alone, a combination of surgery and adjuvant radiotherapy (RT), as well as radiation doses (a–c). Comparisons of overall survival between patients treated with surgery alone (red) and surgery plus adjuvant RT (black) in: (a) the entire cohort, p = 0.0001; (b) female patients only, p = 0.002; and (c) male patients only, p = 0.03. (d–f) Comparisons of overall survival among patients treated with radiation ≥50 Gy (black), <50 Gy (red) and patients never exposed to radiotherapy (blue) in: (d) the entire cohort, p = 0.0001; (e) only female, p = 0.0005; and (f) only male patients, p = 0.07.
Figure 4
Figure 4
Forest plot for the hazard ratio of the clinical variables and MCPyV-status. * For both sexes, differences are shown in Table 2. ** For both sexes, differences are shown in Table 3.
See this image and copyright information in PMC

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