Browse by author
Lookup NU author(s): Dr Tom Andrew, Professor Ruth Plummer, Professor Penny Lovat, Aidan Rose
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024 American Academy of Dermatology, Inc. Background: Merkel cell carcinoma (MCC) is a highly aggressive cutaneous malignancy for which accurate prognostication is necessary to support clinical management. Objective: (1) To determine which survival endpoint—disease-specific death (DSD) or overall survival (OS)—was better stratified by MCC American Joint Cancer Committee eighth edition staging. (2) To develop a multivariable model for enhanced MCC survival predictions. Methods: A retrospective analysis of 10,958 histologically confirmed MCC patients between January 2000 and December 2020 was performed. Patient and tumor features were analyzed from 2 cohorts: a US cohort and an external validation UK cohort. A multivariable Fine and Gray competing risk (FG) model was utilized to account for the competing risk. Results: DSD demonstrated greater discriminatory power as a survival endpoint when compared with OS. Multivariate FG analysis identified the most impactful features of DSD: truncal lesions (subdistribution hazard ratios [SHRs] = 1.96, P <.001), age >84 years (SHR = 1.79, P <.001), male sex (SHR = 1.34, P <.001), and marital status (SHR = 1.09, P <.001). A second FG model incorporating those impactful features enhanced survival predictions beyond current MCC staging criteria alone in both the US (C-index 0.75 vs 0.64, P <.001) and external validation UK cohort (C-index 0.77). Conclusions: MCC staging can stratify DSD better than OS. Additional patient and tumor features enhanced prognostication beyond current staging systems.
Author(s): Andrew TW, Erdmann S, Alrawi M, Plummer R, Shalhout SZ, Sondak V, Brownell I, Lovat PE, Rose A
Publication type: Article
Publication status: Published
Journal: Journal of the American Academy of Dermatology
Year: 2024
Pages: Epub ahead of print
Online publication date: 20/11/2024
Acceptance date: 31/10/2024
Date deposited: 05/02/2025
ISSN (print): 0190-9622
ISSN (electronic): 1097-6787
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.jaad.2024.10.096
DOI: 10.1016/j.jaad.2024.10.096
PubMed id: 39577698
Altmetrics provided by Altmetric
