title: Organ transplant recipients with Merkel cell carcinoma have reduced progression-free, overall, and disease-specific survival independent of stage at presentation.
abstract: BACKGROUND
  Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Immunosuppression is associated with increased incidence of MCC.
  
  
  OBJECTIVE
  We sought to determine whether solid organ transplant recipients (SOTR) with MCC had decreased progression-free, disease-specific, and overall survival compared with immunocompetent patients.
  
  
  METHODS
  We conducted a retrospective cohort study examining 8 SOTR with MCC and 89 immunocompetent control subjects. Cox regression models were generated for outcomes of progression, disease-specific death, and death from any cause, adjusted for patient sex, age at diagnosis, and stage at presentation.
  
  
  RESULTS
  SOTR had a 4.1-fold increased hazard for progression (95% confidence interval 1.57-10.95, P=.004), a 10.5-fold increased hazard for all-cause mortality (95% confidence interval 3.06-35.98, P<.0001), and an 11.9-fold increased hazard for MCC-specific death (95% confidence interval 2.67-53.08, P=.001), adjusted for sex, age, and stage at presentation. SOTR had decreased 1-year overall survival, 46.8% versus 88.6%, and decreased 1-year MCC-specific survival, 56.3% versus 95.2%.
  
  
  CONCLUSIONS
  This is a single-center study from a tertiary academic care center, and may not be generalizable to all patient populations.
  
  
  CONCLUSIONS
  SOTR have a significant reduction in overall, MCC-specific, and progression-free survival compared with immunocompetent patients. Further studies will determine whether aggressive treatment may improve outcomes in this high-risk population.
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Arron
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Theresa
authors.initials: T
authors.lastname: Canavan
authors.affiliation: Department of Dermatology, University of California, San Francisco, California. Electronic address: yus@derm.ucsf.edu.
authors.forename: Siegrid S
authors.initials: SS
authors.lastname: Yu
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015266:Carcinoma, Merkel Cell / Q000276:immunology* / Q000401:mortality* / Q000601:surgery; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007121:Immunocompetence / Q000502:physiology; D016867:Immunocompromised Host / Q000276:immunology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016377:Organ Transplantation / Q000379:methods / Q000401:mortality*; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000276:immunology* / Q000401:mortality* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Merkel cell carcinoma; organ transplant; outcomes; survival