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Increasing Tumor Thickness is Associated with Recurrence and Poorer Survival in Patients with Merkel Cell Carcinoma

  • Translational Research and Biomarkers
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine tumor usually occurring on sun-exposed skin in elderly patients. Clinical and pathologic factors associated with disease progression and mortality in patients with MCC are poorly defined. Recently, it has been reported that p63 expression in primary MCC is strongly associated with clinical outcome.

Methods

MCC patients diagnosed between July 1, 1993 and July 31, 2009 were identified from the surgical pathology records of the Sydney South West Area Health Service. Clinical, pathologic, treatment, and survival data were obtained and immunohistochemical analyses for p53, p63, and Ki-67 were performed. The associations of clinical and pathologic features with disease-free and disease-specific survival were analyzed.

Results

Ninety-five patients were identified (67 males, 28 females; median age at diagnosis of primary MCC 76 [range, 42–93] years). Increasing primary tumor thickness was significantly associated with poorer disease-free survival (5-year survival 18 % in tumors >10 mm thick compared with 69 % for patients with tumors ≤10 mm thick, p = 0.002) and disease-specific survival (5-year survival 74 % in tumors >10 mm thick compared with 97 % for patients with tumors ≤10 mm thick, p = 0.006). There was a strong positive correlation between the Ki-67 index (proportion of Ki-67-positive tumor nuclei) and tumor thickness (r = 0.39, n = 45, p = 0.008). Positive staining for p63 in MCC was infrequent (9 % of primary MCC) and showed no significant association with disease outcome.

Conclusions

Tumor thickness is significantly associated with disease-free survival in MCC. We recommend that primary tumor thickness be routinely recorded in the pathology reports of patients with primary MCC.

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Acknowledgment

The authors are grateful to Ms. Robyn Soper and the laboratory staff (in particular Chitra de Silva and Trina Lum) at Royal Prince Alfred Hospital for preparation of the sections and immunohistochemical stains.

Disclosure

RAS is supported by the Cancer Institute NSW Clinical Research Fellowship Program. There are no other financial disclosures.

Author information

Author notes

  1. Rajmohan Murali MD, FRCPA

    Present address: Department of Pathology, and Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Authors and Affiliations

  1. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Cathy S. Lim MBBS, FRCPA, Rajmohan Murali MD, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

  2. Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia

    Cathy S. Lim MBBS, FRCPA

  3. School of Medicine, University of Western Sydney, Sydney, NSW, Australia

    Cathy S. Lim MBBS, FRCPA

  4. Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Deborah Whalley MBBS, FRANZCR & George Hruby MBBS, FRANZCR

  5. Melanoma Institute Australia, North Sydney, NSW, 2060, Australia

    Lauren E. Haydu BSCHE, MIPH, Rajmohan Murali MD, FRCPA, John F. Thompson MD, FACS, FRACS & Richard A. Scolyer MD, FRCPA, FRCPath

  6. Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Lauren E. Haydu BSCHE, MIPH & John F. Thompson MD, FACS, FRACS

  7. Symbion Laverty Pathology, Macquarie Park, NSW, Australia

    Jill Tippett MBChB, FRCPA

  8. Discipline of Medicine, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    George Hruby MBBS, FRANZCR

  9. Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Rajmohan Murali MD, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

  10. Department of Melanoma and Surgical Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    John F. Thompson MD, FACS, FRACS

  11. Department of Anatomical Pathology, Concord Hospital, Sydney, NSW, Australia

    Jill Tippett MBChB, FRCPA

  12. Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia

    Deborah Whalley MBBS, FRANZCR

Authors
  1. Cathy S. Lim MBBS, FRCPA
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  2. Deborah Whalley MBBS, FRANZCR
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Corresponding author

Correspondence to John F. Thompson MD, FACS, FRACS.

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Lim, C.S., Whalley, D., Haydu, L.E. et al. Increasing Tumor Thickness is Associated with Recurrence and Poorer Survival in Patients with Merkel Cell Carcinoma. Ann Surg Oncol 19, 3325–3334 (2012). https://doi.org/10.1245/s10434-012-2509-x

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  • DOI: https://doi.org/10.1245/s10434-012-2509-x

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