Narrow resection margins are not associated with mortality or recurrence in patients with Merkel cell carcinoma: a retrospective study
Résumé
Background: Wide local excision constitutes the standard of care for Merkel cell carcinoma, but the optimal margin width remains controversial.Objectives: To assess whether narrow margins (0.5 - 1 cm) were associated with outcome.Methods: Patients were recruited from a retrospective French multicentric cohort and included if they had had excision of primary tumor with minimum lateral margins of 0.5 cm. Factors associated with mortality and recurrence were assessed by multivariate regression.Results: Among the 214 patients included, 58 (27.1%) had undergone excision with narrow margins (0.5-1cm) versus 156 (72.9%) with wide margins (>1cm). During a median follow-up of 50.7 months, cancer-specific survival did not differ between groups [5-year specific survival rate 76.8% (95% CI 61.7-91.9) and 76.2% (95% CI 68.8-83.6)]. Overall survival, any recurrence-free survival and local recurrence-free survival did not significantly differ between groups. Cancer-specific mortality was associated with age, male sex, AJCC stage III, positive margins.Limitations: Retrospective design, heterogenous baseline characteristics between groups.Conclusion: Excision with narrow margins was not associated with outcome in this cohort, in which most patients had clear margins and post-operative radiation therapy. Residual tumor, mostly found on deep surgical margins, was independently associated with prognosis.
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