Cancer Medicine (Nov 2022)

Lymph node ratio predicts efficacy of postoperative radiation therapy in nonmetastatic Merkel cell carcinoma: A population‐based analysis

  • Giuseppe Lamberti,
  • Elisa Andrini,
  • Giambattista Siepe,
  • Cristina Mosconi,
  • Valentina Ambrosini,
  • Claudio Ricci,
  • Paola Valeria Marchese,
  • Gianluca Ricco,
  • Riccardo Casadei,
  • Davide Campana

DOI
https://doi.org/10.1002/cam4.4773
Journal volume & issue
Vol. 11, no. 22
pp. 4204 – 4213

Abstract

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Abstract Background After radical resection of a nonmetastatic Merkel cell carcinoma (M0 MCC), postoperative radiation therapy (RT) is recommended as it improves survival. However, the role of RT in specific subgroups of M0 MCC is unclear. We sought to identify whether there is a differential survival benefit from RT in specific M0 MCC patient subgroups. Methods M0 MCC patients from the Surveillance, Epidemiology, and End Results (SEER) database registry were collected. The best prognostic age, tumor size, and lymph node ratio (LNR, ratio between positive lymph nodes and resected lymph nodes) cutoffs were calculated. The primary endpoint was overall survival (OS). Results A total of 5644 M0 MCC patients (median age 77 years, 62% male) were included: 4022 (71%) node‐negative (N0) and 1551 (28%) node‐positive (N+). Overall, 2682 patients (48%) received RT. Age > 76.5 years, tumor size >13.5 mm, and LNR >0.215 were associated with worse OS. RT was associated with longer OS in the M0 MCC, N0, and N+ group and independently associated with a 25%, 27%, and 26% reduction in the risk for death, respectively. RT benefit on survival was increased in tumor size >13.5 mm in the N0 group and LNR >0.215 in the N+ group. No OS benefit from RT was observed in T4 tumors (N0 and N+ groups). Conclusions RT was associated with improved survival in M0 MCC, irrespective of the nodal status. LNR >0.215 is a useful prognostic factor for clinical decision‐making and for stratification and interpretation of clinical trials.

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