TY - JOUR
T1 - Adjuvant Radiation Therapy and Chemotherapy in Merkel Cell Carcinoma
T2 - Survival Analyses of 6908 Cases from the National Cancer Data Base
AU - Bhatia, Shailender
AU - Storer, Barry E.
AU - Iyer, Jayasri G.
AU - Moshiri, Ata
AU - Parvathaneni, Upendra
AU - Byrd, David
AU - Sober, Arthur J.
AU - Sondak, Vernon K.
AU - Gershenwald, Jeffrey E.
AU - Nghiem, Paul
N1 - Publisher Copyright:
© 2016 The Author 2016. Published by Oxford University Press. All rights reserved.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background: Merkel cell carcinoma (MCC) has a high risk of recurrence after initial surgical therapy. Adjuvant radiation therapy (RT) and chemotherapy may be used to reduce the risk of locoregional and systemic recurrence, respectively, but there are conflicting data regarding their impact on survival. We performed a retrospective analysis of MCC cases from the National Cancer Data Base (NCDB) to assess whether adjuvant therapy was associated with differences in survival. Methods: Six thousand nine hundred and eight MCC patients with staging, treatment, and survival data were included. Multivariable analyses were conducted for overall survival (OS) with various treatment modalities while adjusting for prognostic variables including age, sex, comorbidities (Charlson/Deyo score), margin status, primary tumor site and size, and lymph node status. All statistical tests were two-sided. Results: For localized MCC (stage I: n = 3369, stage II: n = 1474), surgery plus adjuvant RT was associated with statistically significantly better OS than with surgery alone in multivariable analyses (stage I: hazard ratio [HR] = 0.71, 95% confidence interval [CI] = 0.64 to 0.80, P <. 001; stage II: HR = 0.77, 95% CI = 0.66 to 0.89, P <. 001). In patients with regional nodal metastases (stage III: n = 2065), neither adjuvant RT nor chemotherapy was associated with statistically significantly improved or worsened OS. Conclusions: In this study of the largest MCC cohort reported to date, adjuvant RT was associated with improved OS in stages I-II MCC. Neither adjuvant RT nor chemotherapy was associated with improved OS in stage III MCC. These results, with the limitations of retrospective analyses, are consistent with earlier studies suggesting benefit with adjuvant RT but do not support the routine use of adjuvant chemotherapy in MCC.
AB - Background: Merkel cell carcinoma (MCC) has a high risk of recurrence after initial surgical therapy. Adjuvant radiation therapy (RT) and chemotherapy may be used to reduce the risk of locoregional and systemic recurrence, respectively, but there are conflicting data regarding their impact on survival. We performed a retrospective analysis of MCC cases from the National Cancer Data Base (NCDB) to assess whether adjuvant therapy was associated with differences in survival. Methods: Six thousand nine hundred and eight MCC patients with staging, treatment, and survival data were included. Multivariable analyses were conducted for overall survival (OS) with various treatment modalities while adjusting for prognostic variables including age, sex, comorbidities (Charlson/Deyo score), margin status, primary tumor site and size, and lymph node status. All statistical tests were two-sided. Results: For localized MCC (stage I: n = 3369, stage II: n = 1474), surgery plus adjuvant RT was associated with statistically significantly better OS than with surgery alone in multivariable analyses (stage I: hazard ratio [HR] = 0.71, 95% confidence interval [CI] = 0.64 to 0.80, P <. 001; stage II: HR = 0.77, 95% CI = 0.66 to 0.89, P <. 001). In patients with regional nodal metastases (stage III: n = 2065), neither adjuvant RT nor chemotherapy was associated with statistically significantly improved or worsened OS. Conclusions: In this study of the largest MCC cohort reported to date, adjuvant RT was associated with improved OS in stages I-II MCC. Neither adjuvant RT nor chemotherapy was associated with improved OS in stage III MCC. These results, with the limitations of retrospective analyses, are consistent with earlier studies suggesting benefit with adjuvant RT but do not support the routine use of adjuvant chemotherapy in MCC.
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U2 - 10.1093/jnci/djw042
DO - 10.1093/jnci/djw042
M3 - Article
C2 - 27245173
AN - SCOPUS:84989167864
SN - 0027-8874
VL - 108
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 9
M1 - djw042
ER -