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The following is a summary of “A multivariable disease specific model enhances prognostication beyond current Merkel cell carcinoma staging: an international cohort study of 10,958 patients.,” published in the November 2024 issue of Dermatology by Andrew et al. 

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer that requires accurate prognostication for effective clinical management.  

Researchers conducted a retrospective study to determine which survival endpoint—disease-specific death (DSD) or overall survival (OS)—was better stratified by MCC AJCC 8th edition staging and to develop a multivariable model for improved survival predictions.  

They assessed 10,958 histologically confirmed MCC cases between January 2000 and December 2020. Patient and tumor characteristics were examined across 2 cohorts: US and UK external validation cohorts. A multivariable Fine and Gray Competing Risk (FG) model was used to adjust for competing risks.  

The results showed that DSD had superior discriminatory power as a survival endpoint compared to OS. Multivariate FG analysis identified critical factors for DSD, including truncal lesions (sub distribution hazard ratio [SHR] 1.96, P <.001), age over 84 years (SHR 1.79, P <.001), male sex (SHR 1.34, P <.001), and marital status (SHR 1.09, P <.001). A second FG model that included the significant features improved survival predictions beyond current MCC staging, with a higher C-index in both the US cohort (0.75 vs 0.64, P <.001) and the external validation cohort (C-index 0.77).  

Investigators concluded the MCC staging better stratifies DSD than overall survival, and additional patient and tumor features improve prognostication beyond current staging systems. 

Source: jaad.org/article/S0190-9622(24)03232-8/fulltext