Treatment and survival of Merkel cell carcinoma since 1993: a population-based cohort study in the Netherlands

Sanne E Uitentuis, Marieke W J Louwman, Alexander C J van Akkooi, Marcel Bekkenk
Journal of the American Academy of Dermatology 2019 January 28

BACKGROUND: Merkel cell carcinoma (MCC) is a rare and potentially lethal skin-cancer. MCC is known for its potential rapid growth and its propensity to metastasise.

OBJECTIVE: To describe the incidence, treatment and survival of MCC in a population-based setting.

METHODS: All MCC's diagnosed in the Netherlands between 1993 and 2016 were selected from the Netherlands Cancer Registry. Patient and tumour characteristics, therapy and vital status were obtained. Cox' proportional hazards were computed and relative survival analyses were performed.

RESULTS: Our cohort included 1977 patients with MCC. Incidence increased from 0.17/100,000 personyears in 1993 to 0.59/100,000 in 2016. The mean age at diagnosis was 75.5. Most MCC's (59.8%), were treated with surgery alone. Relative five-year survival was low (63.0%) and did not improve. Mortality was higher among males (HR: 1.24, 95%CI: 1.11-1.39), higher age (HR 1.07, 95%CI: 1.06-1.07) and nodal (HR1.26, 95%CI: 1.08-1.48) and distant spread of disease (HR2.44, 95%CI: 1.99-2.99).

LIMITATIONS: We lacked data on cause of death, comorbidity and pathological margins, which may have led to misinterpretation of the data.

CONCLUSION: This study shows continuously increasing incidence rates of MCC in the Netherlands. Survival after MCC diagnosis remained low. Our results emphasise the need for implementation of new therapies.

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