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Association Between Treatment Center Experience and Survival After Diagnosis of Stage I–III Merkel Cell Carcinoma
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Using the National Cancer Database, cases of stage I–III Merkel cell carcinoma (MCC; N=11,119) were sorted into those treated at high treatment center volume (TCV) institutions versus low TVC institutions. At a median follow-up of 28.8 months, the 2-year overall survival was greater at high TCV facilities (70.9% vs 63.6%; P < .0001). This was maintained for stage I to II tumors (76.8% vs 68.2%; P < .0001) and stage III tumors (59.2% vs 52.9%; P = .0013). Each increment of 9 cases/year was associated with a 3% overall survival improvement.
- Overall survival of MCC improved when patients were treated at high-volume institutions, possibly due to the increased familiarity with multidisciplinary care paths available at these institutions. Physicians treating patients with curative MCC may consider referring to these centers in order for patients to have access to clinical trials and specialty expertise.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersMerkel cell carcinoma (MCC) is a rare malignancy whose variable management across institutions influences outcomes.1,2 Prior studies demonstrated improved overall survival (OS) at high treatment center volume (TCV) institutions.3,4 Yet, it remains unknown if this OS benefit extends to all curative stages and across treatment approaches. This study characterizes TCV’s impact on OS for stage I-III MCC treated with surgery-alone or postoperative radiotherapy (RT). Additionally, TCV was examined to identify the minimum number of annual cases needed to attain the OS benefit.
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Association Between Treatment Center Experience and Survival After Diagnosis of Stage I–III Merkel Cell Carcinoma Treated With Surgery With or Without Postoperative Radiation Therapy
J Am Acad Dermatol 2020 Nov 07;[EPub Ahead of Print], FE Chipidza, M Thakuria, JD Schoenfeld, AW Silk, PJ Catalano, CH Yoon, GJ Hanna, JA DeCaprio, RB Tishler, DN MargalitFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The stakes for managing Merkel cell carcinoma (MCC) are high given that recurrences arise in approximately 40% of patients. National guidelines indicate that MCC patients should receive multidisciplinary consultation with dermatology, surgery, radiation oncology, and medical oncology practitioners who are familiar with this unique disease.
The current study of 11,119 MCC patients in the National Cancer Database indicates that receiving care from a team that is familiar with MCC management does indeed save lives. The authors evaluated survival among patients in multiple subgroups: patients with localized disease, those with nodal disease, patients who received surgery only, and those who also received adjuvant radiation. In every case, there was a significant survival advantage for patients who received care at a facility with a higher treatment center volume. These findings across risk subsets are consistent with prior studies of MCC patients taken as a whole, which showed improved survival if care was at a center with more experience.
What is a high-volume center for MCC? Facilities that cared for at least 5 MCC cases per year are in the top 10%; the bar is thus not very high. Interestingly, for each additional 3 patients per year, the chance of survival among MCC patients treated at that center increased by 1%.
This means we have work to do because the majority (55%) of MCC patients are treated at a center that sees fewer than 5 MCC cases per year and are associated with poorer outcomes. There are, in fact, dozens of centers across the United States that have an established team interested in MCC (see www.merkelcell.org/centers). Such facilities have higher MCC treatment volumes and thus would be associated with improved outcomes. This study reinforces what should be apparent to those who are tracking the literature: MCC management is rapidly evolving, and MCC patients benefit from being cared for by teams that are actively engaged in managing this tricky tumor.