Quantitative Metastatic Lymph Node Burden and Survival in Merkel Cell Carcinoma.

Quantitative Metastatic Lymph Node Burden and Survival in Merkel Cell Carcinoma.:

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Quantitative Metastatic Lymph Node Burden and Survival in Merkel Cell Carcinoma.

J Am Acad Dermatol. 2020 Jan 16;:

Authors: Nguyen AT, Luu M, Lu DJ, Hamid O, Mallen-St Clair J, Faries MB, Gharavi NM, Ho AS, Zumsteg ZS

Abstract

BACKGROUND: Current lymph node (LN) staging for Merkel cell carcinoma (MCC) does not account for number of metastatic LNs, which is a primary driver of survival in multiple cancers.

OBJECTIVE: To determine the impact of number of positive LNs on survival in MCC.

METHODS: Patients with MCC undergoing surgery were identified from the NCDB and SEER. The association between LN number and survival was modeled with restricted cubic splines. A novel nodal classification system was derived using recursive partitioning analysis (RPA).

RESULTS: Among 3670 patients, increasing metastatic LN number was associated with decreased survival (P<0.001). Mortality risk increased continuously with each additional positive LN using multivariable, non-linear modeling. Using a novel staging system derived via RPA, the hazard ratio for death in multivariable regression in comparison to patients without LN involvement was 1.24 (P=0.049), 2.08 (P<0.001), 3.24 (P<0.001), and 6.13 (P<0.001) for the proposed N1a (1-3 LNs with microscopic detection), N1b (1-3 LNs with macroscopic detection), N2 (4-8 LNs), and N3 (≥9 LNs), respectively. This system was validated in the SEER cohort and demonstrated improved concordance compared to AJCC 8th edition.

LIMITATIONS: Retrospective design CONCLUSIONS: Number of metastatic LNs is the dominant nodal factor driving survival in patients with MCC.

PMID: 31954753 [PubMed - as supplied by publisher]