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Radiation, Lymph Node Dissection, or Both: Management of Lymph Node Micrometastases from Merkel Cell Carcinoma

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Abstract

Background

Regional lymph node micrometastases from Merkel cell carcinoma (MCC) can be treated with completion lymph node dissection (CLND) and/or radiation therapy (RT). It is unclear how these options compare in terms of survival benefits for patients.

Patients and Methods

This retrospective cohort study used data from years 2012–2019 of the National Cancer Database. Patients with MCC and clinically negative, but pathologically positive, lymph node metastases who received RT to and/or CLND of the regional lymph node basin were included. Inverse probability weight balancing was performed using covariates followed by Cox proportional hazards modeling for survival analysis.

Results

A total of 962 patients were included [median (interquartile range) age, 74 (67–80) years, 662 (68.8%) male patients, 926 (96.3%) white patients]. The majority (63%, n = 606) had a CLND only, while 18% (n = 173) had RT only, and 19% (n = 183) had both CLND and RT. From 2016 to 2019, usage of RT only increased from 10% to 31.8%. Multivariate analysis demonstrated that treatment modality was not associated with survival [RT versus CLND, hazard ratio (HR) 0.842, 95% confidence interval (CI) 0.621–1.142, p = 0.269, RT+CLND versus CLND, HR 1.029, 95% CI 0.775–1.367, p = 0.844]. This persisted after balancing weights (RT versus CLND, HR 0.837, 95% CI 0.614–1.142, p = 0.262, RT+CLND versus CLND, HR 1.085, 95% CI 0.801–1.470, p = 0.599).

Conclusions

The usage of RT for nodal micrometastasis in MCC is increasing as compared with CLND. This strategy appears to be safe, with no significant difference in survival outcomes.

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Data Availability

All data used in this study are from the National Cancer Database (https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/). The authors do not own this data and hence are not permitted to share them in the original form.

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Author notes

  1. Giorgos C. Karakousis and John T. Miura are sharing co-senior authorship.

Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Kevin L. Ma BS, Cimarron E. Sharon MD, Gabriella N. Tortorello MD, Giorgos C. Karakousis MD & John T. Miura MD

  2. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Nikhita J. Perry BS

  3. Department of Epidemiology and Biostatistics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Luke J. Keele PhD

  4. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    John N. Lukens MD

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Contributions

Study conception or design was carried out by KLM, CES, GNT, GCK, and JTM. Data acquisition, analysis, or interpretation was carried out by KLM, CES, and LJK. Drafting or critically revising the work was carried out by KLM, CES, GNT, LJK, JNL, GCK, and JTM.

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Correspondence to Giorgos C. Karakousis MD.

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Ma, K.L., Sharon, C.E., Tortorello, G.N. et al. Radiation, Lymph Node Dissection, or Both: Management of Lymph Node Micrometastases from Merkel Cell Carcinoma. Ann Surg Oncol 30, 4345–4355 (2023). https://doi.org/10.1245/s10434-023-13437-z

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