Tumor vascularization and clinicopathologic parameters as prognostic factors in merkel cell carcinoma

BackgroundMerkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. The incidence of the disease has undergone a significant increase in recent years, which is caused by an increase in the average age of the population and in the use of immunosuppressive therapies. MCC is an aggressive pathology, which metastasizes early to the lymph nodes. These characteristics impose an accurate diagnostic analysis of the regional lymph node district with radiography, clinical examination and sentinel node biopsy. In recent years, there has been a breakthrough in the treatment of the advanced pathology thanks to the introduction of monoclonal antibodies acting on the PD-1/PD-L1 axis. This study aimed to describe the clinico-pathological characteristics, treatment strategies and prognostic factors of MCC.MethodsA retrospective cohort study was conducted involving 143 consecutive patients who were diagnosed and/or treated for MCC. These patients were referred to the Veneto Institute of Oncology IOV-IRCCS and to the University Hospital of Padua (a third-level center) in the period between December 1991 and January 2020. In the majority of cases, diagnosis took place at the IOV. However, some patients were diagnosed elsewhere and subsequently referred to the IOV for a review of the diagnosis or to begin specific therapeutic regimens.Results143 patients, with an average age of 71 years, were affected mainly with autoimmune and neoplastic comorbidities. Our analysis has shown that age, autoimmune comorbidities and the use of therapy with immunomodulating drugs (which include corticosteroids, statins and beta-blockers) are associated with a negative prognosis. In this sense, male sex is also a negative prognostic factor.ConclusionsAutoimmune and neoplastic comorbidities were frequent in the studied population. The use of drugs with immunomodulatory effects was also found to be a common feature of the population under examination. The use of this type of medication is considered a negative prognostic factor. The relevance of a multidisciplinary approach to the patient with MCC is confirmed, with the aim of assessing the risks and benefits related to the use of immunomodulating therapy in the individual patient.

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Prognostic factors in Merkel cell carcinoma patients undergoing sentinel node biopsy

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2017.05.013 ◽

2017 ◽

Vol 43 (8) ◽

pp. 1536-1541 ◽

Cited By ~ 6

Author(s):

I. Mattavelli ◽

R. Patuzzo ◽

V. Torri ◽

G. Gallino ◽

A. Maurichi ◽

...

Keyword(s):

Prognostic Factors ◽

Sentinel Node ◽

Cell Carcinoma ◽

Sentinel Node Biopsy ◽

Merkel Cell Carcinoma ◽

Merkel Cell ◽

Node Biopsy

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Merkel cell carcinoma: Identification of prognostic factors unique to tumors located in the head and neck based on analysis of SEER data

The Laryngoscope ◽

10.1002/lary.23222 ◽

2012 ◽

Vol 122 (6) ◽

pp. 1283-1290 ◽

Cited By ~ 55

Author(s):

Valerie A. Smith ◽

E. Ramsay Camp ◽

Eric J. Lentsch

Keyword(s):

Prognostic Factors ◽

Cell Carcinoma ◽

Head And Neck ◽

Merkel Cell Carcinoma ◽

Merkel Cell ◽

Seer Data

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Immune status in merkel cell carcinoma: Relationships with clinical factors and independent prognostic value.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21509 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21509-e21509

Author(s):

Mehran Yusuf ◽

Jeremy T. Gaskins ◽

Abbas Rattani ◽

Grant McKenzie ◽

Steven Mandish ◽

...

Keyword(s):

Prognostic Factors ◽

Cell Carcinoma ◽

Merkel Cell Carcinoma ◽

Immune Status ◽

Solid Organ Transplantation ◽

Adjuvant Radiation ◽

Solid Organ ◽

Merkel Cell ◽

Immortal Time Bias ◽

Staging Systems

e21509 Background: Immunosuppression (IS) is not currently considered in staging for Merkel cell carcinoma (MCC). We performed an analysis of the National Cancer Database (NCDB) to investigate immune status as an independent predictor of overall survival (OS) for patients with MCC and describe the relationship between immune status and other prognostic factors. Methods: The NCDB was queried for patients diagnosed with MCC from 2010 to 2016 with known immune status. Multivariable Cox proportional hazards models were used to define factors associated with OS. Adjuvant radiation and chemotherapy were treated as time-dependent predictors to limit immortal time bias. Secondary models were constructed to assess the association between IS etiology and OS. Multivariable logistic regression models were used to characterize relationships between immune status and other factors. Multiple imputation was used to minimize missing data bias. Results: The overall cohort included 3,882 patients (3,470 patients with known immunocompetence and 412 patients with known immunosuppression). Etiologies for profound IS included chronic lymphocytic leukemia (CLL, n = 118), Other including HIV/AIDS (n = 116), solid-organ transplant (n = 106), and Non-Hodgkin Lymphoma (NHL, n = 72). 2,864 patients (73.8%) underwent surgical nodal examination. The median follow-up time was 33 months (Interquartile Range: 18 to 55 months). The 3-year OS was lower for patients with IS (44.6%, CI 39.8-49.9%) compared to immunocompetent (IC) patients (68.7%, CI 67.1-70.4%, p < .0001). IS was associated with increased adjusted mortality hazard (HR 2.36, 95% CI 2.03-2.75). Etiology of IS was associated with OS ( p = .0015) with lowest 3-year OS (32.7%, CI 24.6%-43.5%) for patients with solid-organ transplantation. IS was associated with increased odds of greater nodal burden (OR 1.70, CI 1.37-2.11) and lymphovascular invasion (OR 1.58, CI 1.23-2.03). Conclusions: Immune status was independently prognostic for OS for patients with localized MCC. Etiology of IS may be associated with differential survival outcomes. Multiple adverse prognostic factors were associated with increased likelihood of IS. Immune status and potentially etiology of IS may be useful prognostic factors to consider for future MCC staging systems.

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