Surgical resection improves median overall survival with marginal improvement in long-term survival when compared with definitive radiotherapy in Merkel cell carcinoma: A propensity score matched analysis of the National Cancer Database

Background: Definitive radiotherapy has been suggested as a treatment alternative to surgical resection in Merkel cell carcinoma (MCC). Methods: Patients with MCC were identified from the National Cancer Database. Propensity score matching accounting for age, Charlson-Deyo score, grade, and AJCC stage was used to match patients in 1: 1 fashion by primary treatment (surgery vs. radiotherapy). Results: There were 1227 patients in each group. Median overall survival was improved with surgical resection in stage I/II (76 vs. 25 months, p < 0.001) and stage III disease (30 vs. 15 months, p < 0.001). For stage I/II, 5- and 8-year overall survival were 61% and 42%, in the surgical resection and 32% and 25% in the definitive radiotherapy groups, respectively. For stage III, 5- and 8-year overall survival were 34% and 21% for surgical resection and 19% and 16% in the radiotherapy group, respectively. Conclusions: Surgical resection for MCC improves median survival compared to definitive radiotherapy while marginally improving long-term survival. (C) 2017 Elsevier Inc. All rights reserved.