Which factors are poor prognostic indicators in Merkel cell carcinoma (MCC)?

Updated: Jan 18, 2019
  • Author: Arjun S Joshi, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Poor prognostic factors include the stage of disease at presentation, which is influenced by presence of nodal and/or distant disease. In particular, the presence of nodal disease influences survival and the likelihood of metastatic disease. Median survival for patients with positive nodes is 13 months, compared with 40 months for those with negative nodes. Primary tumor size does not predict nodal disease. [22]

The location of the primary tumor also appears to be a poor prognostic factor. Within the head and neck, lip tumors have a high rate of invasion into bone, cartilage, and muscle and are associated with decreased survival. [23] Lesions affecting the lower limbs are associated with a high rate of local-regional failure because of the difficulty of surgical resection and radiation therapy at these sites. In addition, lesions on the lower extremities have a propensity for early dermal lymphatic infiltration. Other poor prognostic factors are age older than 60 years, male sex, a primary lesion >2 cm, and a lack of radiation therapy.

Tumor thickness is a significant risk factor for 5-year mortality. Patients with tumors thicker than 10 mm have 18% survival over 5 years compared with 69% in patients with tumors thinner than 10 mm. [24]

MCC is associated with the Merkel cell polyomavirus (MCV), with studies showing up to 80% involvement in MCC tumors. [5, 6, 7] The prognostic risk associated with MCV is unclear, as there has been conflicting data on the subject. [16]

Certain transcription factors, such as HATH-1 and Brn-3c, are being studied as prognostic factors for MCC. Whether these are linked to MCC is unknown at this time. Expression of p63, a transcription factor within the p53 family, is associated with reduced overall survival. [25] P-cadherin expression is associated with increased recurrence-free survival. [26]


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