Survival of patients with head and neck Merkel cell carcinoma

November 5, 2023


JAMA Network

Publication Date

November 5, 2023


Nayak AL, Pickett AT, Delisle M, Dingley B, Mallick R, Hamilton T, Stuart H, Talbot M, McKinnon G, Jost E, Thiboutot E, Francescutti V, Samman S, Easson A, Schellenberg A, Merchant S, La J, Vanderbeck K, Wright F, Berger-Richardson D, Hebbard P, Hershorn O, Younan R, Patocskai E, Rodriguez-Qizilbash S, Meguerditichian A, Tchuente V, Kazandjian S, Mathieson A, Hossain F, Hetu J, Corsten M, Tohmé A, Nessim C, Johnson-Obaseki S Summary

This study aimed to assess the impact of treatments on the survival of patients with Merkel cell carcinoma (MCC) specifically affecting their head or neck. Canadian researchers analyzed data from 400 such patients, revealing that approximately half had early-stage disease localized to one area (Stage I) without spreading to lymph nodes or other organs. Among MCC patients of all stages, including those with localized and metastatic (spreading) disease, those who had both radiation and surgery appeared to have improved survival compared to those who had only surgery, though the survival difference lacked statistical significance. It’s important to note that the analysis included patients with various disease stages, so the findings may not apply broadly to individuals with different stages and MCC characteristics.


Importance: Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. Due to its relatively low incidence and limited prospective trials, current recommendations are guided by historical single-institution retrospective studies.

Objective: To evaluate the overall survival (OS) of patients in Canada with head and neck MCC (HNMCC) according to American Joint Committee on Cancer 8th edition staging and treatment modalities.

Design, setting, and participants: A retrospective cohort study of 400 patients with a diagnosis of HNMCC between July 1, 2000, and June 31, 2018, was conducted using the Pan-Canadian Merkel Cell Cancer Collaborative, a multicenter national registry of patients with MCC. Statistical analyses were performed from January to December 2022.

Main outcomes and measures: The primary outcome was 5-year OS. Multivariable analysis using a Cox proportional hazards regression model was performed to identify factors associated with survival.

Results: Between 2000 and 2018, 400 patients (234 men [58.5%]; mean [SD] age at diagnosis, 78.4 [10.5] years) with malignant neoplasms found in the face, scalp, neck, ear, eyelid, or lip received a diagnosis of HNMCC. At diagnosis, 188 patients (47.0%) had stage I disease. The most common treatment overall was surgery followed by radiotherapy (161 [40.3%]), although radiotherapy alone was most common for stage IV disease (15 of 23 [52.2%]). Five-year OS was 49.8% (95% CI, 40.7%-58.2%), 39.8% (95% CI, 26.2%-53.1%), 36.2% (95% CI, 25.2%-47.4%), and 18.5% (95% CI, 3.9%-41.5%) for stage I, II, III, and IV disease, respectively, and was highest among patients treated with surgery and radiotherapy (49.9% [95% CI, 39.9%-59.1%]). On multivariable analysis, patients treated with surgery and radiotherapy had greater OS compared with those treated with surgery alone (hazard ratio [HR], 0.76 [95% CI, 0.46-1.25]); however, this was not statistically significant. In comparison, patients who received no treatment had significantly worse OS (HR, 1.93 [95% CI, 1.26-2.96)].

Conclusions and relevance: In this cohort study of the largest Canada-wide evaluation of HNMCC survival outcomes, stage and treatment modality were associated with survival. Multimodal treatment was associated with greater OS across all disease stages.

View the clinical publication