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

Authors :
Bryant MK
Ward C
Gaber CE
Strassle PD
Ollila DW
Laks S
Source :
Journal of surgical oncology [J Surg Oncol] 2020 Sep; Vol. 122 (4), pp. 653-659. Date of Electronic Publication: 2020 Jun 20.
Publication Year :
2020

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.<br />Objective: We sought to evaluate the impact of known clinicopathological determinants and immunosuppression on the risk of recurrence and mortality of MCC patients.<br />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.<br />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).<br />Limitations: Retrospective review with a prolonged observation period and changing treatment modalities.<br />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.<br /> (© 2020 Wiley Periodicals LLC.)

Details

Language :
English
ISSN :
1096-9098
Volume :
122
Issue :
4
Database :
MEDLINE
Journal :
Journal of surgical oncology
Publication Type :
Academic Journal
Accession number :
32562583
Full Text :
https://doi.org/10.1002/jso.26048