Reduced Wide Local Excision Margins are Associated with Increased Risk of Relapse and Death from Merkel Cell Carcinoma
- PDF / 314,926 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 106 Downloads / 154 Views
ORIGINAL ARTICLE – MELANOMA
Reduced Wide Local Excision Margins are Associated with Increased Risk of Relapse and Death from Merkel Cell Carcinoma Neal Andruska, MD, PhD1, Lily Mahapatra, MD, PhD2, Randall J. Brenneman, MD, PhD1, Jason T. Rich, MD3, Brian C. Baumann, MD1, Leigh Compton, MD, PhD2,4, Wade L. Thorstad, MD1, and Mackenzie D. Daly, MD1 1
Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO; 2Department of Pathology and Immunology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO; 3Department of Otolaryngology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO; 4Division of Dermatology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO
ABSTRACT Introduction. Current recommendations regarding the size of wide local excision (WLE) margins for Merkel cell carcinoma (MCC) are not well established. Methods. WLE and pathologic margins were respectively reviewed from 79 patients with stage I or II MCC, who underwent WLE at Washington University in St Louis from 2005 to 2019. Outcomes included local recurrencefree survival (LRFS), regional recurrence-free survival (RRFS), distant recurrence-free survival (DRFS), diseasefree survival (DFS), and disease-specific survival (DSS). Results. Thirty-two percent of patients received adjuvant radiotherapy (aRT). At 1 year, DFS was 51.3%, 71.4%, and 87.8% for patients with WLE margins \ 1 cm, 1–1.9 cm, and C 2 cm, respectively (p = 0.02). At 3 years, the DSS was 57.7%, 82.6%, and 100% for patients with WLE margins \ 1 cm, 1–1.9 cm, and C 2 cm, respectively (p = 0.02). Multivariable Cox analysis demonstrated that every 1-cm increase in WLE margins was associated
Neal Andruska and Lily Mahapatra are co-first authors contributed equally to this work. Ó Society of Surgical Oncology 2020 First Received: 26 May 2020 Accepted: 3 August 2020 M. D. Daly, MD e-mail: [email protected]
with improved RRFS [hazard ratio (HR) = 0.28, 95% confidence interval (CI): 0.11–0.75], DRFS (HR 0.30, CI 0.08–0.99), DFS (HR 0.42, CI 0.21–0.86), and DSS (HR 0.16, CI 0.04–0.61). WLE and pathologic margin size were moderately-to-strongly correlated (r = 0.66). Close or positive pathologic margins (\ 3 mm) were associated with reduced DRFS (HR 6.83, CI 1.80–25.9), DFS (HR 2.98, CI 1.31–6.75), and DSS (HR 3.52, CI 1.14–10.9). Conclusion. Reduced WLE and pathologic margins were associated with higher risk of relapse and death from MCC. Larger WLE margins are important in populations with lower rates of adjuvant radiation.
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin cancer with an estimated 2500 cases per year in the United States.1 The incidence has tripled over the past 20 years, and the impact of MCC on public health is growing.1 Prognosis is closely linked to the stage at presentation with stage I and II disease representing localized disease, stage III representing nodal disease, and stage IV representing distant me
Data Loading...
