Merkel cell carcinoma: A retrospective analysis of urban vs. rural survival outcomes from the United States’ National Cancer Institute, a SEER based study

Clinical Surgical Oncology Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI:10.1016/j.cson.2026.100120

Grace Evelyn Steinback, Joycie Chang, Anand Rajpara, Michael Siscos

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Abstract

Background

Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine malignancy with poor survival outcomes, particularly among patients with barriers to timely care. Rural populations may experience delayed diagnosis and treatment due to geographic, socioeconomic, and healthcare access disparities.

Methods

A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database (2010–2021). Adults aged 25–90 years with a confirmed MCC diagnosis were included classified by Rural–Urban Continuum Codes (RUCC): metropolitan counties (RUCC 1–3) and rural counties (RUCC 4–9). MCC-specific survival was evaluated using Kaplan–Meier analysis and compared using the log-rank test. Descriptive statistics were used to compare baseline characteristics.

Results

A total of 2357 patients were identified; most were elderly, white, and male. 1965 (83.4%) resided in metropolitan counties and 392 (16.6%) in rural counties. Rural patients demonstrated lower county-level median household incomes compared with metropolitan residents. MCC-specific deaths occurred in 429 (21.8%) metropolitan residents and 102 (26.0%) rural residents. Five-year MCC-specific survival was 71.6% among metropolitan residents versus 65.6% among rural residents, (log-rank p = 0.064). Five-year cumulative survival was 51.3% among metropolitan residents compared with 46.0% among rural residents, with Kaplan-Meier curves showing a statistically significant divergence (log-rank p < 0.05).

Conclusion

Using an RUCC-based definition of rurality (RUCC 4–9), rural residence was associated with a lower 5-year MCC-specific survival and worse cumulative 5-year survival. Although the difference among MCC-specific survival did not reach conventional statistical significance, this disparity may be clinically meaningful and warrants further investigation using adjusted models.

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默克尔细胞癌：来自美国国家癌症研究所的城市和农村生存结果的回顾性分析，一项基于SEER的研究

背景：默克尔细胞癌（MCC）是一种侵袭性皮肤神经内分泌恶性肿瘤，生存预后较差，特别是在无法及时治疗的患者中。由于地理、社会经济和医疗保健机会的差异，农村人口可能会经历延迟诊断和治疗。方法采用监测、流行病学和最终结果（SEER）数据库（2010-2021）进行回顾性队列研究。25-90岁确诊MCC的成年人按城乡连续编码（RUCC）分类：大都市县（RUCC 1-3）和农村县（RUCC 4-9）。使用Kaplan-Meier分析评估mcc特异性生存，并使用log-rank检验进行比较。描述性统计用于比较基线特征。结果共检出2357例患者；大多数是老年人、白人和男性。1965人（83.4%）居住在大都市县，392人（16.6%）居住在农村县。农村患者的家庭收入中位数低于城市居民。城市居民中有429人（21.8%）死亡，农村居民中有102人（26.0%）死亡。都市居民5年mcc特异性生存率为71.6%，农村居民为65.6% （log-rank p = 0.064）。都市居民的5年累积生存率为51.3%，而农村居民为46.0%，Kaplan-Meier曲线显示有统计学意义的差异（log-rank p < 0.05）。根据基于ucc的乡村性定义（RUCC 4-9），农村居住与较低的mcc特异性5年生存率和较差的累积5年生存率相关。虽然mcc特异性生存率的差异没有达到传统的统计学意义，但这种差异可能具有临床意义，值得使用调整后的模型进行进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Clinical Surgical Oncology

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