Differential Outcomes Among Immunosuppressed Patients With Merkel Cell Carcinoma Impact of Immunosuppression Type on Cancer-specific and Overall Survival

被引:34
作者
Cook, Maclean [1 ]
Baker, Kelsey [4 ]
Redman, Mary [4 ]
Lachance, Kristina [1 ]
Nguyen, Macklin H. [5 ]
Parvathaneni, Upendra [2 ]
Bhatia, Shailender [3 ]
Nghiem, Paul [1 ]
Tseng, Yolanda D. [2 ]
机构
[1] Univ Washington, Div Dermatol, Seattle, WA 98195 USA
[2] Univ Washington, Dept Radiat Oncol, 1959 NE Pacific St,POB 356043, Seattle, WA 98195 USA
[3] Univ Washington, Div Med Oncol, Seattle, WA 98195 USA
[4] Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA
[5] Univ Washington, Sch Med, Seattle, WA USA
来源
AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS | 2019年 / 42卷 / 01期
关键词
Merkel cell carcinoma; immunosuppression; HIV/AIDS; CLL; solid organ transplant; outcomes; ORGAN TRANSPLANT RECIPIENTS; SKIN-CANCER; ALLOGRAFT-REJECTION; PROGNOSTIC-FACTOR; THERAPY; TUMOR; IPILIMUMAB; RADIATION; MELANOMA; COUNT;
D O I
10.1097/COC.0000000000000482
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objectives: Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer with higher incidence among whites, elderly, and immunosuppressed patients. Although immunosuppressed MCC patients are at higher risk of recurrence and MCC-related death, it is unknown whether immunosuppression type is associated with differential outcomes. Materials and Methods: We retrospectively evaluated 89 non-metastatic MCC patients with a diagnosis of chronic immunosuppression. Immunosuppression was categorized as chronic lymphocytic leukemia (31% of cohort), other hematologic malignancies (18%), solid organ transplant (21%), autoimmune disease (21%), and human immunodeficiency virus acquired deficiency syndrome (8%). Progression-free survival (PFS) and MCC-specific survival (MSS) were estimated with the cumulative incidence function. Overall survival (OS) was estimated by the Kaplan-Meier method. Results: With a median follow-up of 52 months, 53 deaths occurred (42 from MCC, 7 unknown, and 4 non-MCC). Two-year PFS, MSS, and OS were 30%, 55%, and 52%, respectively. Human immunodeficiency virus/acquired deficiency syndrome and solid organ transplant patients were diagnosed with MCC at a younger age (median 55 and 59 y, respectively) and with more advanced stage disease compared with other immunosuppressed subgroups. PFS did not significantly differ among the 5 immunosuppression subgroups (P=0.30), but significant differences were observed in MSS and OS (both P=0.01). Controlling for potential confounders for OS, including age and stage, immunosuppression type was still significantly associated with risk of death (P=0.01). Conclusions: Among immunosuppressed MCC patients, recurrent MCC is the major cause of mortality. The risk of death from MCC differs among immunosuppression types, suggesting important biological differences in host-tumor immune interactions.
引用
收藏
页码:82 / 88
页数:7
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