A multivariable disease specific model enhances prognostication beyond current Merkel cell carcinoma staging: an international cohort study of 10,958 patients.

IF 12.8 1区医学 Q1 DERMATOLOGY

Journal of the American Academy of Dermatology Pub Date : 2024-11-20 DOI:10.1016/j.jaad.2024.10.096

Tom W Andrew, Sophie Erdmann, Mogdad Alrawi, Ruth Plummer, Sophia Z Shalhout, Vern Sondak, Isaac Brownell, Penny E Lovat, Aidan Rose

{"title":"A multivariable disease specific model enhances prognostication beyond current Merkel cell carcinoma staging: an international cohort study of 10,958 patients.","authors":"Tom W Andrew, Sophie Erdmann, Mogdad Alrawi, Ruth Plummer, Sophia Z Shalhout, Vern Sondak, Isaac Brownell, Penny E Lovat, Aidan Rose","doi":"10.1016/j.jaad.2024.10.096","DOIUrl":null,"url":null,"abstract":"Background: Merkel cell carcinoma (MCC) is a highly aggressive cutaneous malignancy for which accurate prognostication is necessary to support clinical management.Objective: 1. To determine which survival endpoint - disease-specific-death (DSD) or overall survival (OS)- was better stratified by MCC AJCC 8th edition staging. 2. To develop a multivariable model for enhanced MCC survival predictions.Methods: Retrospective analysis of 10,958 histologically confirmed MCC between January 2000 and December 2020 was performed. Patient and tumor features were analysed from two cohorts: a US cohort and an external validation UK cohort. A multivariable Fine and Gray Competing Risk (FG) model was utilised to account for competing risk.Results: DSD demonstrated greater discriminatory power as a survival endpoint when compared to OS. Multivariate FG analysis identified the most impactful features for DSD: truncal lesions (subdistribution hazard ratios (SHR) 1.96, p<.001), age >84 years (SHR 1.79, p<.001), male sex (SHR 1.34, p<.001) and marital status (SHR 1.09, p<.001). A second FG model incorporating those impactful features enhanced survival predictions beyond current MCC staging criteria alone in both US (C-index 0.75 vs 0.64, p<.001) and external validation cohorts. cohort (C-index 0.77).Conclusions: MCC staging can stratify DSD better than OS. Additional patient and tumour features enhanced prognostication beyond current staging systems.","PeriodicalId":17198,"journal":{"name":"Journal of the American Academy of Dermatology","volume":" ","pages":""},"PeriodicalIF":12.8000,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Dermatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jaad.2024.10.096","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DERMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Merkel cell carcinoma (MCC) is a highly aggressive cutaneous malignancy for which accurate prognostication is necessary to support clinical management.

Objective: 1. To determine which survival endpoint - disease-specific-death (DSD) or overall survival (OS)- was better stratified by MCC AJCC 8^th edition staging. 2. To develop a multivariable model for enhanced MCC survival predictions.

Methods: Retrospective analysis of 10,958 histologically confirmed MCC between January 2000 and December 2020 was performed. Patient and tumor features were analysed from two cohorts: a US cohort and an external validation UK cohort. A multivariable Fine and Gray Competing Risk (FG) model was utilised to account for competing risk.

Results: DSD demonstrated greater discriminatory power as a survival endpoint when compared to OS. Multivariate FG analysis identified the most impactful features for DSD: truncal lesions (subdistribution hazard ratios (SHR) 1.96, p<.001), age >84 years (SHR 1.79, p<.001), male sex (SHR 1.34, p<.001) and marital status (SHR 1.09, p<.001). A second FG model incorporating those impactful features enhanced survival predictions beyond current MCC staging criteria alone in both US (C-index 0.75 vs 0.64, p<.001) and external validation cohorts. cohort (C-index 0.77).

Conclusions: MCC staging can stratify DSD better than OS. Additional patient and tumour features enhanced prognostication beyond current staging systems.

查看原文本刊更多论文

多变量疾病特异性模型超越了目前的梅克尔细胞癌分期，提高了预后效果：一项对 10958 名患者进行的国际队列研究。

背景：梅克尔细胞癌（MCC）是一种侵袭性很强的皮肤恶性肿瘤，需要准确的预后来支持临床治疗。目的：1.确定疾病特异性死亡（DSD）和总生存期（OS）这两种生存终点在MCC AJCC第8版分期中哪个分层效果更好。2.2. 建立一个多变量模型，以提高 MCC 的生存预测能力：对 2000 年 1 月至 2020 年 12 月间 10958 例经组织学确诊的 MCC 进行回顾性分析。分析了两个队列中的患者和肿瘤特征：一个美国队列和一个外部验证的英国队列。利用多变量Fine and Gray竞争风险（FG）模型来考虑竞争风险：结果：与OS相比，DSD作为生存终点的判别能力更强。多变量FG分析确定了对DSD影响最大的特征：截状病变（亚分布危险比（SHR）1.96，p84年（SHR 1.79，p结论：MCC分期可对DSD进行分层：MCC分期比OS更能对DSD进行分层。额外的患者和肿瘤特征增强了预后效果，超过了目前的分期系统。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of the American Academy of Dermatology 医学-皮肤病学

CiteScore

8.60

自引率

5.80%

发文量

2023

审稿时长

49 days

期刊介绍： The Journal of the American Academy of Dermatology (JAAD) is the official scientific publication of the American Academy of Dermatology (AAD). Its primary goal is to cater to the educational requirements of the dermatology community. Being the top journal in the field, JAAD publishes original articles that have undergone peer review. These articles primarily focus on clinical, investigative, and population-based studies related to dermatology. Another key area of emphasis is research on healthcare delivery and quality of care. JAAD also highlights high-quality, cost-effective, and innovative treatments within the field. In addition to this, the journal covers new diagnostic techniques and various other topics relevant to the prevention, diagnosis, and treatment of skin, hair, and nail disorders.