A recent study has shed light on improving the prognostication of Merkel cell carcinoma (MCC), a rare and aggressive form of skin cancer. The study, which analysed data from 10,958 patients with histologically confirmed MCC between January 2000 and December 2020, aimed to determine the most effective survival endpoint for predicting patient outcomes and to develop a model for more accurate survival predictions.
The study compared two survival endpoints: disease-specific death (DSD) and overall survival (OS), finding that DSD provided greater discriminatory power for stratification according to the American Joint Committee on Cancer (AJCC) 8th edition staging criteria.
A multivariable model, using the Fine and Gray Competing Risk approach, was then developed to improve predictions. The analysis revealed that certain factors had a significant impact on DSD, including truncal lesions, age over 84 years, male sex, and marital status. Notably, these factors enhanced survival predictions when incorporated into a new model. The model’s performance improved the predictive accuracy in both a U.S. cohort (C-index of 0.75 vs. 0.64) and an external UK cohort (C-index of 0.77), surpassing current MCC staging systems.
The findings emphasise the importance of refining staging criteria to better predict outcomes for MCC patients and suggest that incorporating additional patient and tumour features could significantly improve prognostication. These insights could lead to more tailored treatment strategies and improved patient care.
Helena Bradbury, EMJ
Reference
Andrew TW et al. A multivariable disease specific model enhances prognostication beyond current Merkel cell carcinoma staging: an international cohort study of 10,958 patients. 2024:S0190-9622(24)03232-8.
