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Reduced Wide Local Excision Margins are Associated with Increased Risk of Relapse and Death from Merkel Cell Carcinoma

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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 recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant recurrence-free survival (DRFS), disease-free 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 ≥ 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 ≥ 2 cm, respectively (p = 0.02). Multivariable Cox analysis demonstrated that every 1-cm increase in WLE margins was associated 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.

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Acknowledgments

This work was supported in part by institutional funds from the Departments of Radiation Oncology and Pathology & Immunology, and the Siteman Cancer Center at Washington University in St Louis School of Medicine.

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Author notes

  1. Neal Andruska and Lily Mahapatra are co-first authors contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA

    Neal Andruska MD, PhD, Randall J. Brenneman MD, PhD, Brian C. Baumann MD, Wade L. Thorstad MD & Mackenzie D. Daly MD

  2. Department of Pathology and Immunology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA

    Lily Mahapatra MD, PhD & Leigh Compton MD, PhD

  3. Department of Otolaryngology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA

    Jason T. Rich MD

  4. Division of Dermatology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA

    Leigh Compton MD, PhD

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  1. Neal Andruska MD, PhD
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Correspondence to Mackenzie D. Daly MD.

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Andruska, N., Mahapatra, L., Brenneman, R.J. et al. Reduced Wide Local Excision Margins are Associated with Increased Risk of Relapse and Death from Merkel Cell Carcinoma. Ann Surg Oncol 28, 3312–3319 (2021). https://doi.org/10.1245/s10434-020-09145-7

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