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20 year review of Merkel Cell Carcinoma from a Single Institution: The Cleveland Clinic Experience
George Collis, MD; Raymond Isakov, MD
Cleveland Clinic
2014-02-27
Presenter: George Collis
Affidavit:
All data collection and analysis was performed by resident under supervision of Dr Isakov.
Director Name: Steven Bernard; Raymond Isakov
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Our aim is to review outcomes for merkel cell carcinoma (MCC) from a single, high-volume institution and evaluate different modes of treatment for this cancer.
Methods: A retrospective review over 20 years was performed. Multiple treatment modalities were compared. Lymph node status and surgical margins were also evaluated. Disease-free survival and overall survival were the primary outcomes.
Results: 69 patients presented with MCC between 1/1/1993 to 1/1/2013. Median follow-up was 33 months [range, 0 to 162]. 22 patients underwent surgery alone, 31 underwent surgery and radiation, 2 underwent surgery and chemotherapy, 7 underwent all three. Recurrence rates were 45%, 32%, 50%, and 29%, respectively. Average disease-free survival was 21, 42, 2, and 72 months, respectively. Average overall survival was 37, 61, 14, and 82 months, respectively. 21% of patients had a prior history of solid organ transplantation or systemic immunosuppression at the time of diagnosis. The recurrence rate in transplant patients was 60%, average disease-free survival was 9 months, and overall survival was 17 months. Patients with lymph node involvement had an overall survival of 46 months compared to 51 months without nodal involvement. Average survival with distant metastasis was 21 months. Local-regional recurrence rate was 50% with margins under 2 cm and 34% with margins of 2 cm or more.
Conclusion: While no ideal treatment regimen for MCC exists, multi-modality treatment with surgery and radiation is most widely instituted at this time. Additional benefit from adjuvant chemotherapy needs further investigation.
