title: The role of adjuvant therapy in the management of head and neck merkel cell carcinoma: an analysis of 4815 patients.
abstract: OBJECTIVE
  Merkel cell carcinoma (MCC) is a rare neuroendocrine malignant neoplasm that most commonly occurs in the head and neck and is rapidly increasing in incidence. The role of adjuvant chemoradiotherapy (CRT) in the management of head and neck MCC remains controversial.
  
  
  OBJECTIVE
  To evaluate the association between different adjuvant therapies and survival in head and neck MCC.
  
  
  METHODS
  Retrospective review of adult patients with head and neck MCC who had surgery recorded in the National Cancer Data Base from 1998 to 2011.
  
  
  METHODS
  Surgical excision, adjuvant radiation therapy (RT), or adjuvant CRT.
  
  
  METHODS
  Our main outcome was overall survival (OS). Statistical analysis included χ2, t tests, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis.
  
  
  RESULTS
  We identified 4815 patients; 92.0% underwent standard surgical excision, and 8.0% underwent Mohs surgery. On multivariate analysis, age at least 75 years (hazard ratio [HR], 2.83 [95% CI, 1.82-4.41]), larger tumor size, positive margins (HR, 1.52 [95% CI, 1.25-1.85]), and metastatic lymph nodes (HR, 2.29 [95% CI, 1.84-2.85]) were independently associated with decreased OS. Postoperative CRT (HR, 0.62 [95% CI, 0.47-0.81]) and RT (HR, 0.80 [95% CI, 0.70-0.92]) provided a survival benefit over surgery alone. Adjuvant CRT was associated with improved OS over adjuvant RT in patients with positive margins (HR, 0.48 [95% CI, 0.25-0.93]), tumor size at least 3 cm (HR, 0.52 [95% CI, 0.30-0.90]), and male sex (HR, 0.69 [95% CI, 0.50-0.94]).
  
  
  CONCLUSIONS
  To our knowledge, this the first study examining the role of adjuvant CRT in head and neck MCC. Results suggest that adjuvant CRT may help improve survival in high-risk patients, such as males and those with positive margins and larger tumors.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Chen
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina3Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Judson
mesh_terms: D000367:Age Factors; D000368:Aged; D015266:Carcinoma, Merkel Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012737:Sex Factors