Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis.

McEvoy Aubriana M; Kristina Lachance; Hippe Daniel S; Kelsey Cahill; Yasman Moshiri; Lewis Christopher W; Neha Singh; Park Song Y; Zoe Thuesmunn; Cook Maclean M; Alexander Nora A; Lauren Zawacki; Hannah Thomas; Paulson Kelly G; Paul Nghiem

Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis.

McEvoy Aubriana M, Kristina Lachance, Hippe Daniel S, Kelsey Cahill, Yasman Moshiri, Lewis Christopher W, Neha Singh, Park Song Y, Zoe Thuesmunn, Cook Maclean M, Alexander Nora A, Lauren Zawacki, Hannah Thomas, Paulson Kelly G, Paul Nghiem

Research output: Contribution to journal › Article

Abstract

Importance: Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). Stage-specific recurrence data that includes time from diagnosis would provide more precise prognostic information and contribute to risk-appropriate clinical surveillance.

Objective: To estimate risk of stage-specific MCC recurrence and mortality over time since diagnosis.

Design, Setting, and Participants: This prospective cohort study included 618 patients with MCC who were prospectively enrolled in a Seattle-based data repository between 2003 and 2019. Of these patients, 223 experienced a recurrence of MCC. Data analysis was performed July 2019 to November 2021.

Main Outcomes and Measures: Stage-specific recurrence and survival, as well as cumulative incidence and Kaplan-Meier analyses.

Results: Among the 618 patients included in the analysis (median [range] age, 69 [11-98] years; 227 [37%] female), the 5-year recurrence rate for MCC was 40%. Risk of recurrence in the first year was high (11% for patients with pathologic stage I, 33% for pathologic stage IIA/IIB, 30% for pathologic stage IIIA, 45% for pathologic stage IIIB, and 58% for pathologic stage IV), with 95% of recurrences occurring within the first 3 years. Median follow-up among living patients was 4.3 years. Beyond stage, 4 factors were associated with increased recurrence risk in univariable analyses: immunosuppression (hazard ratio [HR], 2.4; 95% CI, 1.7-3.3; P

Conclusions and Relevance: In this cohort study, the MCC recurrence rate (approximately 40%) was notably different than that reported for invasive melanoma (approximately 19%), squamous cell carcinoma (approximately 5%-9%), or basal cell carcinoma (approximately 1%-2%) following definitive therapy. Because more than 90% of MCC recurrences arise within 3 years, it is appropriate to adjust surveillance intensity accordingly. Stage- and time-specific recurrence data can assist in appropriately focusing surveillance resources on patients and time intervals in which recurrence risk is highest.

Original language	American English
Journal	Articles, Abstracts, and Reports
State	Published - Apr 1 2022

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Aubriana M, M., Lachance, K., Daniel S, H., Cahill, K., Moshiri, Y., Christopher W, L., Singh, N., Song Y, P., Thuesmunn, Z., Maclean M, C., Nora A, A., Zawacki, L., Thomas, H., Kelly G, P., & Nghiem, P. (2022). Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis. Articles, Abstracts, and Reports. http://digitalcommons.psjhealth.org/publications/5922

@article{4d0f981efecb4d78b5ef8359fade1e84,

title = "Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis.",

abstract = "Importance: Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). Stage-specific recurrence data that includes time from diagnosis would provide more precise prognostic information and contribute to risk-appropriate clinical surveillance. Objective: To estimate risk of stage-specific MCC recurrence and mortality over time since diagnosis. Design, Setting, and Participants: This prospective cohort study included 618 patients with MCC who were prospectively enrolled in a Seattle-based data repository between 2003 and 2019. Of these patients, 223 experienced a recurrence of MCC. Data analysis was performed July 2019 to November 2021. Main Outcomes and Measures: Stage-specific recurrence and survival, as well as cumulative incidence and Kaplan-Meier analyses. Results: Among the 618 patients included in the analysis (median [range] age, 69 [11-98] years; 227 [37%] female), the 5-year recurrence rate for MCC was 40%. Risk of recurrence in the first year was high (11% for patients with pathologic stage I, 33% for pathologic stage IIA/IIB, 30% for pathologic stage IIIA, 45% for pathologic stage IIIB, and 58% for pathologic stage IV), with 95% of recurrences occurring within the first 3 years. Median follow-up among living patients was 4.3 years. Beyond stage, 4 factors were associated with increased recurrence risk in univariable analyses: immunosuppression (hazard ratio [HR], 2.4; 95% CI, 1.7-3.3; P Conclusions and Relevance: In this cohort study, the MCC recurrence rate (approximately 40%) was notably different than that reported for invasive melanoma (approximately 19%), squamous cell carcinoma (approximately 5%-9%), or basal cell carcinoma (approximately 1%-2%) following definitive therapy. Because more than 90% of MCC recurrences arise within 3 years, it is appropriate to adjust surveillance intensity accordingly. Stage- and time-specific recurrence data can assist in appropriately focusing surveillance resources on patients and time intervals in which recurrence risk is highest.",

author = "{Aubriana M}, McEvoy and Kristina Lachance and {Daniel S}, Hippe and Kelsey Cahill and Yasman Moshiri and {Christopher W}, Lewis and Neha Singh and {Song Y}, Park and Zoe Thuesmunn and {Maclean M}, Cook and {Nora A}, Alexander and Lauren Zawacki and Hannah Thomas and {Kelly G}, Paulson and Paul Nghiem",

year = "2022",

month = apr,

day = "1",

language = "American English",

journal = "Articles, Abstracts, and Reports",

}

Aubriana M, M, Lachance, K, Daniel S, H, Cahill, K, Moshiri, Y, Christopher W, L, Singh, N, Song Y, P, Thuesmunn, Z, Maclean M, C, Nora A, A, Zawacki, L, Thomas, H, Kelly G, P & Nghiem, P 2022, 'Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis.', Articles, Abstracts, and Reports. <http://digitalcommons.psjhealth.org/publications/5922>

TY - JOUR

T1 - Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis.

AU - Aubriana M, McEvoy

AU - Lachance, Kristina

AU - Daniel S, Hippe

AU - Cahill, Kelsey

AU - Moshiri, Yasman

AU - Christopher W, Lewis

AU - Singh, Neha

AU - Song Y, Park

AU - Thuesmunn, Zoe

AU - Maclean M, Cook

AU - Nora A, Alexander

AU - Zawacki, Lauren

AU - Thomas, Hannah

AU - Kelly G, Paulson

AU - Nghiem, Paul

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Importance: Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). Stage-specific recurrence data that includes time from diagnosis would provide more precise prognostic information and contribute to risk-appropriate clinical surveillance. Objective: To estimate risk of stage-specific MCC recurrence and mortality over time since diagnosis. Design, Setting, and Participants: This prospective cohort study included 618 patients with MCC who were prospectively enrolled in a Seattle-based data repository between 2003 and 2019. Of these patients, 223 experienced a recurrence of MCC. Data analysis was performed July 2019 to November 2021. Main Outcomes and Measures: Stage-specific recurrence and survival, as well as cumulative incidence and Kaplan-Meier analyses. Results: Among the 618 patients included in the analysis (median [range] age, 69 [11-98] years; 227 [37%] female), the 5-year recurrence rate for MCC was 40%. Risk of recurrence in the first year was high (11% for patients with pathologic stage I, 33% for pathologic stage IIA/IIB, 30% for pathologic stage IIIA, 45% for pathologic stage IIIB, and 58% for pathologic stage IV), with 95% of recurrences occurring within the first 3 years. Median follow-up among living patients was 4.3 years. Beyond stage, 4 factors were associated with increased recurrence risk in univariable analyses: immunosuppression (hazard ratio [HR], 2.4; 95% CI, 1.7-3.3; P Conclusions and Relevance: In this cohort study, the MCC recurrence rate (approximately 40%) was notably different than that reported for invasive melanoma (approximately 19%), squamous cell carcinoma (approximately 5%-9%), or basal cell carcinoma (approximately 1%-2%) following definitive therapy. Because more than 90% of MCC recurrences arise within 3 years, it is appropriate to adjust surveillance intensity accordingly. Stage- and time-specific recurrence data can assist in appropriately focusing surveillance resources on patients and time intervals in which recurrence risk is highest.

AB - Importance: Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). Stage-specific recurrence data that includes time from diagnosis would provide more precise prognostic information and contribute to risk-appropriate clinical surveillance. Objective: To estimate risk of stage-specific MCC recurrence and mortality over time since diagnosis. Design, Setting, and Participants: This prospective cohort study included 618 patients with MCC who were prospectively enrolled in a Seattle-based data repository between 2003 and 2019. Of these patients, 223 experienced a recurrence of MCC. Data analysis was performed July 2019 to November 2021. Main Outcomes and Measures: Stage-specific recurrence and survival, as well as cumulative incidence and Kaplan-Meier analyses. Results: Among the 618 patients included in the analysis (median [range] age, 69 [11-98] years; 227 [37%] female), the 5-year recurrence rate for MCC was 40%. Risk of recurrence in the first year was high (11% for patients with pathologic stage I, 33% for pathologic stage IIA/IIB, 30% for pathologic stage IIIA, 45% for pathologic stage IIIB, and 58% for pathologic stage IV), with 95% of recurrences occurring within the first 3 years. Median follow-up among living patients was 4.3 years. Beyond stage, 4 factors were associated with increased recurrence risk in univariable analyses: immunosuppression (hazard ratio [HR], 2.4; 95% CI, 1.7-3.3; P Conclusions and Relevance: In this cohort study, the MCC recurrence rate (approximately 40%) was notably different than that reported for invasive melanoma (approximately 19%), squamous cell carcinoma (approximately 5%-9%), or basal cell carcinoma (approximately 1%-2%) following definitive therapy. Because more than 90% of MCC recurrences arise within 3 years, it is appropriate to adjust surveillance intensity accordingly. Stage- and time-specific recurrence data can assist in appropriately focusing surveillance resources on patients and time intervals in which recurrence risk is highest.

M3 - Article

JO - Articles, Abstracts, and Reports

JF - Articles, Abstracts, and Reports

ER -

Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis.

Abstract

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