Merkel cell carcinoma: The prognostic implications of an occult primary in stage IIIB (nodal) disease

Foote, Matthew, Veness, Michael, Zarate, Dannie and Poulsen, Michael (2012) Merkel cell carcinoma: The prognostic implications of an occult primary in stage IIIB (nodal) disease. Journal of the American Academy of Dermatology, 67 3: 395-399. doi:10.1016/j.jaad.2011.09.009


Author Foote, Matthew
Veness, Michael
Zarate, Dannie
Poulsen, Michael
Title Merkel cell carcinoma: The prognostic implications of an occult primary in stage IIIB (nodal) disease
Journal name Journal of the American Academy of Dermatology   Check publisher's open access policy
ISSN 0190-9622
1097-6787
Publication date 2012-09
Year available 2011
Sub-type Article (original research)
DOI 10.1016/j.jaad.2011.09.009
Volume 67
Issue 3
Start page 395
End page 399
Total pages 5
Place of publication Philadelphia, PA, United States
Publisher Mosby
Collection year 2012
Language eng
Formatted abstract
Background
Merkel cell carcinoma is a highly aggressive cutaneous malignancy with a high rate of lymph node and distant metastatic disease. Approximately one third of patients present with stage IIIB (nodal) disease.

Objective

This cohort study was performed to analyze the outcome of patients with stage IIIB disease with or without an occult primary.

Methods

The details of 91 patients with stage IIIB (nodal) Merkel cell carcinoma treated curatively between 1985 and 2010 at 3 tertiary referral hospitals in Australia were reviewed. Kaplan-Meier plots were used with the primary end point being overall survival. Secondary end points were disease-free survival and relapse-free survival. A multivariate Cox regression analysis was performed for known prognostic factors.

Results
Of 91 patients with stage IIIB (nodal) disease, 36 (40%) had an occult primary. A total of 78 patients (86%) had surgery and 79 patients (87%) had definitive or adjuvant radiotherapy. With a median follow-up of 4.3 years, those with an occult primary did significantly better in terms of overall survival, disease-free survival, and relapse-free survival. On multivariate analysis, occult primary and patient age were the only factors predicting survival with hazard ratios of 0.30 (95% confidence interval 0.13-0.67) and 1.64 (95% confidence interval 1.13-2.38), respectively.

Limitations

This is a retrospective study over several decades with patients treated using various modalities.

Conclusion

This study indicates that for patients with stage IIIB (nodal) Merkel cell carcinoma, the presence of an occult primary confers a significantly better prognosis that may have implications in the future staging and treatment of patients with stage III disease.
Keyword Merkel cell carcinoma
Nodes
Radiotherapy
Staging
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 26 October 2011.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Fri, 02 Dec 2011, 09:48:12 EST by Matthew Lamb on behalf of School of Medicine