Original articlePathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: Analysis of 5823 cases as the basis of the first consensus staging system
Section snippets
Methods
Cases from the NCDB were identified using MCC-specific histology code 8247. A flow diagram of the MCC cases used for the prognosis and staging analysis is shown in Fig 1. There were 10,020 patients with MCC captured in the NCDB between 1986 and 2004 who were used for basic demographic analyses (Table I). The NCDB policy is to collect follow-up data from the time of initial diagnosis at 5-year intervals. All patients given a diagnosis before the year 2000 (5823 patients) had follow-up data
Results
The clinical and demographic characteristics of 10,020 MCC cases captured by the NCDB are shown in Table I. Similar to smaller, previously reported cohorts,1, 5, 15, 16 men comprised the majority of cases (61%). The age at diagnosis was 50 years or older in 94% of MCC cases and the median age was 76 years. Head/neck presentation was the most common primary site (45%). Non-Caucasian ethnicities were underrepresented in the MCC cohort (4%) as compared with their representation in the US
Discussion
Here we present the prognostic analysis used to derive the first unified staging system for MCC. It is anticipated that this staging system, along with the recent introduction of 7 new MCC-specific diagnostic codes (International Classification of Diseases, Ninth Revision, Clinical Modification),21 will aid in standardizing language used to describe MCC and its prognosis among patients, clinicians, and researchers. This staging system is the result of multidisciplinary consensus meetings that
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Dr Lemos is currently affiliated with the Department of Dermatology, Emory University, Atlanta, GA.
Supported by National Institutes of Health (NIH) K02-AR50993; American Cancer Society (ACS) RSG-08-115-01-CCE; ACS Jerry Wachter Merkel Cell Carcinoma (MCC) Fund; NIH K24-CA139052; an unrestricted educational grant from Schering Pharmaceutical, Kenilworth, NJ; the David & Rosalind Bloom Endowment for MCC Research; and the University of Washington MCC Patient Gift Fund.
Conflicts of interest: None declared.
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These authors contributed equally to this study.