Immune status and the efficacy of adjuvant radiotherapy for patients with localized Merkel cell carcinoma of the head an
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RESEARCH ARTICLE
Immune status and the efficacy of adjuvant radiotherapy for patients with localized Merkel cell carcinoma of the head and neck M. Yusuf1 · J. Gaskins2 · M. E. May1 · S. Mandish1 · W. Wall3 · W. Fisher4 · P. Tennant5 · J. Jorgensen5 · J. Bumpous5 · N. Dunlap1 Received: 2 January 2020 / Accepted: 16 March 2020 © Federación de Sociedades Españolas de Oncología (FESEO) 2020
Abstract Purpose Immunosuppressed (IS) patients are at increased risk for developing Merkel cell carcinoma (MCC) with worsened outcomes compared to immunocompetent (IC) patients. We sought to determine the effects of immune status on the efficacy of adjuvant RT regarding OS for patients with stage I, II or III (localized) MCC of the head and neck. Methods/patients The National Cancer Database was queried for patients with resected, localized MCC of the head and neck with known immune status. Kaplan–Meier methods were used to describe OS. Log-rank tests, multivariable Cox regression models and interaction effect testing were used to compare OS by subgroup categorized by patient and treatment factors including immune status and adjuvant RT receipt. Results A total of 892 (89.6%) IC and 104 (10.4%) IS patients with MCC of the head and neck were included. Adjuvant RT was associated with improved 3-year OS rate for both IS patients (49.4% vs. 35.5%, p = 0.0467) and stage I/II IC patients (72.4% vs. 62.9%, p = 0.0092). Adjuvant RT was associated with decreased hazard of death (HR 0.77, 95% CI 0.62–0.95). Interaction effect testing did not demonstrate a difference in the efficacy of adjuvant RT on OS between IC and IS status (p = 0.157). Conclusions In this NCDB analysis, adjuvant RT was associated with decreased hazard of death for patients with localized MCC of the head and neck regardless of immune status and should be considered for both IS and IC patients. Keywords Merkel cell carcinoma · Immunosuppression · Types of immunosuppression · Radiation therapy
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12094-020-02338-2) contains supplementary material, which is available to authorized users. * M. Yusuf [email protected] 1
Department of Radiation Oncology, School of Medicine, University of Louisville Hospital, 529 S. Jackson St, Louisville, KY 40202, USA
2
Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
3
Department of Dermatology, Medical College of Georgia, Augusta, GA, USA
4
Morsani College of Medicine, University of South Florida, Tampa, FL, USA
5
Department of Otolaryngology‑Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, KY, USA
Merkel cell carcinoma (MCC) is a rare cutaneous neoplasm which often occurs on the skin of the head and neck [1–4]. Merkel cell polyoma virus (MCPyV) and ultraviolet (UV) light exposure are risk factors associated with MCC development and the immunologic system is believed to play a critical role in MCC surveillan
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