A multivariable disease specific model enhances prognostication beyond current Merkel cell carcinoma staging: an international cohort study of 10,958 patients.
Tom W Andrew, Sophie Erdmann, Mogdad Alrawi, Ruth Plummer, Sophia Z Shalhout, Vern Sondak, Isaac Brownell, Penny E Lovat, Aidan Rose
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引用次数: 0
Abstract
Background: Merkel cell carcinoma (MCC) is a highly aggressive cutaneous malignancy for which accurate prognostication is necessary to support clinical management.
Objective: 1. To determine which survival endpoint - disease-specific-death (DSD) or overall survival (OS)- was better stratified by MCC AJCC 8th edition staging. 2. To develop a multivariable model for enhanced MCC survival predictions.
Methods: Retrospective analysis of 10,958 histologically confirmed MCC between January 2000 and December 2020 was performed. Patient and tumor features were analysed from two cohorts: a US cohort and an external validation UK cohort. A multivariable Fine and Gray Competing Risk (FG) model was utilised to account for competing risk.
Results: DSD demonstrated greater discriminatory power as a survival endpoint when compared to OS. Multivariate FG analysis identified the most impactful features for DSD: truncal lesions (subdistribution hazard ratios (SHR) 1.96, p<.001), age >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 incorporating those impactful features enhanced survival predictions beyond current MCC staging criteria alone in both US (C-index 0.75 vs 0.64, p<.001) and external validation cohorts. cohort (C-index 0.77).
Conclusions: MCC staging can stratify DSD better than OS. Additional patient and tumour features enhanced prognostication beyond current staging systems.
期刊介绍：
The Journal of the American Academy of Dermatology (JAAD) is the official scientific publication of the American Academy of Dermatology (AAD). Its primary goal is to cater to the educational requirements of the dermatology community. Being the top journal in the field, JAAD publishes original articles that have undergone peer review. These articles primarily focus on clinical, investigative, and population-based studies related to dermatology. Another key area of emphasis is research on healthcare delivery and quality of care. JAAD also highlights high-quality, cost-effective, and innovative treatments within the field. In addition to this, the journal covers new diagnostic techniques and various other topics relevant to the prevention, diagnosis, and treatment of skin, hair, and nail disorders.
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