The impact of facility characteristics on Merkel cell carcinoma outcomes: A retrospective cohort study.

Abstract

Previous work has suggested that facility-level characteristics, such as case volume and academic affiliation, are associated with patient survival for rare malignancies. Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer with high mortality and rising incidence. The effect of facility characteristics on MCC outcomes is not yet established. We aimed to investigate whether facility academic affiliation or case volume was associated with MCC patient survival. We conducted a retrospective cohort analysis of US adult MCC cases diagnosed during 2004-2014 in the National Cancer Database. Both facility academic affiliation (P < .001) and case volume (P < .001) were significantly associated with patient survival. The 5-year survival of patients treated at academic facilities was 63.0% (standard error [SE] 1.7) and that of a propensity score- matched cohort of patients treated at nonacademic facilities was 53.4% (SE 1.9). The 5-year survival of patients treated at high-case volume facilities was 67.4% (SE 2.1) and that of a propensity score-matched cohort of patients treated at low- and intermediate-case volume facilities was 58.6% (SE 2.0). Disease-specific survival and local recurrence data were not available. Treatment of MCC at academic and high-volume centers is associated with significantly improved patient survival. Further studies evaluating comorbidities and disease-specific survival are needed to establish whether experienced centers have improved outcomes in MCC treatment.