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Immune status and the efficacy of adjuvant radiotherapy for patients with localized Merkel cell carcinoma of the head and neck

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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.

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Acknowledgements

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 employed, or the conclusions drawn from these data by the investigator.

Funding

Departmental funding.

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Authors and Affiliations

  1. Department of Radiation Oncology, School of Medicine, University of Louisville Hospital, 529 S. Jackson St, Louisville, KY, 40202, USA

    M. Yusuf, M. E. May, S. Mandish & N. Dunlap

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

    J. Gaskins

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

    W. Wall

  4. Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    W. Fisher

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

    P. Tennant, J. Jorgensen & J. Bumpous

Authors
  1. M. Yusuf
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  2. J. Gaskins
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  3. M. E. May
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  4. S. Mandish
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  5. W. Wall
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  6. W. Fisher
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  7. P. Tennant
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  8. J. Jorgensen
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  9. J. Bumpous
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  10. N. Dunlap
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Corresponding author

Correspondence to M. Yusuf.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by our institutional review board. All data obtained from the NCDB are de-identified with no details provided that may disclose the identity of subjects. No human or animal studies were performed as part of this study.

Informed consent

The NCDB provides only deidentified patient level data without any identifiable information in accordance with HIPAA recommendations (no information regarding patient health information including the 18 HIPAA identifier domains was available in the dataset/published in the manscript.

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Yusuf, M., Gaskins, J., May, M.E. et al. Immune status and the efficacy of adjuvant radiotherapy for patients with localized Merkel cell carcinoma of the head and neck. Clin Transl Oncol 22, 2009–2016 (2020). https://doi.org/10.1007/s12094-020-02338-2

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  • DOI: https://doi.org/10.1007/s12094-020-02338-2

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