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Immune Status in Merkel Cell Carcinoma: Relationships With Clinical Factors and Independent Prognostic Value

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Abstract

Background

Immunosuppression (IS) currently is not considered in staging for Merkel cell carcinoma (MCC). An analysis of the National Cancer Database (NCDB) was performed to investigate immune status as an independent predictor of overall survival (OS) for patients with MCC and to describe the relationship between immune status and other prognostic factors.

Methods

The NCDB was queried for patients with a diagnosis of MCC from 2010 to 2016 who had known immune status. Multivariable Cox proportional hazards models were used to define factors associated with OS. Secondary models were constructed to assess the association between IS etiology and OS. Multivariable logistic regression models were used to characterize relationships between immune status and other factors.

Results

The 3-year OS was lower for the patients with IS (44.6%) than for the immunocompetent (IC) patients (68.7%; p < 0.0001). Immunosuppression was associated with increased adjusted mortality hazard (hazard ratio [HR], 2.36, 95% confidence interval [CI], 2.03–2.75). The etiology of IS was associated with OS (p = 0.0015), and patients with solid-organ transplantation had the lowest 3-year OS (32.7%). Immunosuppression was associated with increased odds of greater nodal burden (odds ratio [OR], 1.70; 95% CI, 1.37–2.11) and lymphovascular invasion (OR, 1.58; 95% CI, 1.23–2.03).

Conclusions

Immune status was independently prognostic for the OS of patients with localized MCC. The etiology of IS may be associated with differential survival outcomes. Multiple adverse prognostic factors were associated with increased likelihood of IS. Immune status, and potentially the etiology of IS, may be useful prognostic factors to consider for future MCC staging systems.

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Acknowledgment

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA

    Mehran B. Yusuf MD, Abbas Rattani MD, Grant McKenzie MD, Steven Mandish MD, Alyssa Farley BS & Neal Dunlap MD

  2. Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA

    Jeremy Gaskins PhD

  3. Department of Dermatology, Medical College of Georgia, Augusta, GA, USA

    Weston Wall MD

  4. Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, KY, USA

    Paul Tennant MD & Jeffrey Bumpous MD

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  1. Mehran B. Yusuf MD
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  2. Jeremy Gaskins PhD
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  3. Abbas Rattani MD
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Correspondence to Mehran B. Yusuf MD.

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Yusuf, M.B., Gaskins, J., Rattani, A. et al. Immune Status in Merkel Cell Carcinoma: Relationships With Clinical Factors and Independent Prognostic Value. Ann Surg Oncol 28, 6154–6165 (2021). https://doi.org/10.1245/s10434-021-09944-6

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  • DOI: https://doi.org/10.1245/s10434-021-09944-6

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