Prognosis / Survival rates

Survival rates

Survival relates to the percent of patients that will not have died of MCC at various times after diagnosis.

Overview of MCC survival rates

Survival and disease recurrence are two critical measures of prognosis prognosis Relates to the outcome, course of a disease, or chance of cure. (how a patient will do after a cancer cancer A term used to describe diseases in which abnormal cells continually divide without normal regulation. Cancerous cells may invade surrounding tissues and may spread to other regions of the body via blood and the lymphatic system. diagnosis). Recurrence refers to whether the cancer ever comes back (see the Recurrence page to learn more) and “disease-specific survival” refers to whether the cancer leads to death. The figures below show how MCC stage affects survival rates and the chance of death from MCC.

MCC-specific survival relates to the percent of patients that will not have died of MCC at various times after diagnosis. In general, patients with local local Affecting only the site of origin, without evidence of spreading. Compare to systemic. or nodal disease have improved survival compared to patients with distant metastatic metastatic Having to do with the spread of cancer from a primary site of origin to distant areas beyond the draining lymph nodes. disease. Most deaths from MCC occur in the first three years after diagnosis.

Kaplan-Meier curves

“Kaplan-Meier” curves are a standard way to depict both recurrence-free survival and MCC-specific survival over time starting from diagnosis. In the Kaplan-Meier curves shown below, each tick mark indicates a patient who was “censored” at that point and is no longer included in the data to the right of that point. Reasons for “censoring” include no follow up data available beyond that date, or death from a non-MCC cause.

MCC-specific survival for 234 patients with stage I or II MCC
MCC-specific survival for 234 patients with stage I or II MCC. These data are from patients with stage IA (n= 118), stage IB (n= 61), stage IIA (n= 32) and stage IIB (n= 23) MCC enrolled in the Seattle-based MCC cohort through December 2015. Staging was per AJCC 7th Edition system.
MCC-specific survival for 238 patients with stage III or IV MCC.
MCC-specific survival for 238 patients with stage III or IV MCC. These data are from patients with stage IIIA (n=81), stage IIIB (n=127) and stage IV (n=30) in the Seattle based MCC cohort through December 2015. Staging was per AJCC 7th Edition system.
MCC-specific survival for 237 patients with stage IIIA, stage IIIB with known or unknown primary tumors and with stage IV.
MCC-specific survival for 237 patients with stage IIIA, stage IIIB with known or unknown primary tumors and with stage IV. Some patients present without an identifiable primary MCC tumor (lesion) on the skin. These patients are referred to as having an “unknown primary tumor” and often present instead with an enlarged lymph node containing MCC. Stage IIIB patients with a known primary tumor have a poorer outcome relative to Stage IIIB patients with an unknown primary tumor. At three years, MCC specific survival for unknown primary tumor is about 80% versus 45% in known tumor patients, 80% stage IIIA, and 15% in stage IV. These data are from patients with stage IIIA (n=81), stage IIIB known primary tumors (n=59) and stage IIIB unknown primary tumors (n=68) and stage IV (n= 29) enrolled in the Seattle based MCC cohort through December 2015. Staging was per AJCC 7th Edition system.

How physicians determine your prognosis

At the time of diagnosis, your medical team will ‘ stage stage Physicians determine the stage of cancer by performing physical exams and tests. Stages describe the extent of cancer within the body, especially whether the disease has spread (metastasized) from the primary site to other parts of the body. ’ your cancer. The stage is based on many factors including the size of the tumor, the results of a sentinel lymph node biopsy and scans, etc. Please see the Staging page to learn more. The stage of the cancer can predict the chances of having a recurrence of MCC.

A Closer Look

A recent manuscript analyzed Overall Survival (chance of dying of anything) based on the new 8th edition staging system 1. The Nghiem lab is currently analyzing MCC Specific (disease specific) survival and recurrence rates for this new staging system and that information will be posted here sometime in 2017, after the 8th Edition AJCC staging system goes into use.

What to do next

Using information about stage as well as how long it has been since diagnosis, these graphs can help determine how much ‘risk’ remains and thus how frequent physician visits should be.

FAQs

What are my chances of beating Merkel cell carcinoma?

Your chance of beating MCC depends on how advanced the disease was when it was diagnosed, what treatment you receive and if your immune system is functioning properly. The “stage” of your cancer refers to whether the cancer is only in the skin, has spread to the lymph nodes or has spread elsewhere in the body. In general, about 1/3 of all MCC patients will succumb to this disease.

How can I increase my chances of survival?

You can increase your chance of survival by working with a team of doctors that is familiar with the unique management of MCC. In most cases, getting a sentinel lymph node biopsy is the best way to determine how advanced your cancer is. MCC is not the same as small cell lung cancer, and thus should usually not be treated with chemotherapy alone. Similarly, MCC is not the same as melanoma, and thus extra consideration should be taken before treating with surgery alone. Another important aspect of your treatment is to continue to eat a healthy diet and get regular exercise to help keep your immune system and overall health strong.

What immune problems make beating MCC more difficult?

People with severe defects in “T lymphocytes” (key cells of the immune system) have a 10-30 times greater chance of developing MCC and twice the chance of losing the battle with MCC compared to people with a normal immune system. The conditions that cause such severe T lymphocyte defects include HIV (AIDS), taking immune suppressive drugs after solid organ transplantation, and certain immune cancers such as chronic lymphocytic leukemia. In contrast, suffering from more “colds” than average will not importantly affect your ability to fight MCC.

Understand the Science

The following clinical publications and scientific research provide additional in-depth information about survival rates.

Analysis of Prognostic Factors from 9387 Merkel Cell Carcinoma Cases Forms the Basis for the New 8th Edition AJCC Staging System.

The first consensus Merkel cell carcinoma (MCC) staging system was published in 2010. New information on the clinical course prompts review of MCC staging. Methods: A total of 9387 MCC cases from the National Cancer Data Base Participant User File with follow-up and staging data (1998–2012) were a...

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