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<p>Merkel cell carcinoma (MCC) is an aggressive skin malignancy with rising incidence. Prior studies suggest sociodemographic factors influence outcomes, but data in the immunotherapy era are limited. This study evaluates the association between sociodemographic characteristics and MCC presentation, treatment, and survival in the immunotherapy era. We conducted a retrospective population-based cohort study using National Cancer Database data from 2016 to 2020 to evaluate associations between sociodemographic factors, disease presentation, treatment, and survival in MCC during the immunotherapy era. We observed differences in presentation, treatment, and outcomes by race, insurance status, and socioeconomic status. Black patients had 1.52-fold higher odds of presenting with stage II disease (95% CI 1.09–2.12) and 1.41-fold higher odds of stage III/IV disease (95% CI 1.25–1.59) compared to White patients, along with longer median treatment delays (25.5 vs. 19.7 days, <i>p</i> &lt; 0.05). Shorter time-to-treatment was independently associated with improved survival (HR 0.89; 95% CI 0.83–0.95). Overall treatment rates were high (97.41%), but uninsured patients had higher amputation rates (1.47% vs. 0.37%, <i>p</i> &lt; 0.001) and were twice as likely to receive no treatment (5.88% vs. 3.13%, <i>p</i> &lt; 0.001) versus privately insured patients. Five-year survival differed across SES quartiles (45.99% vs. 55.09% for lowest vs. highest, <i>p</i> &lt; 0.001). In multivariable analysis adjusting for age, sex, stage, comorbidity, and treatment, only SES remained an independent predictor of survival, with the highest quartile showing a 17% lower mortality risk (adj-HR 0.83; 95% CI 0.71–0.96). In conclusion, SES was the strongest independent predictor of survival (adj-HR 0.83 for highest vs. lowest quartile) in this national MCC cohort, with additional differences by race, insurance, and geography in disease presentation and treatment patterns. These findings highlight the importance of considering sociodemographic factors in managing MCC in the immunotherapy era.</p>

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Factors associated with presentation, treatment, and survival in Merkel cell carcinoma during the immunotherapy era

  • 期刊论文

  • 发表日期：

    2026年1月4日

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  • Rachel C. Chang,
  • Elise K. Brunsgaard,
  • David C. Reid

摘要

Merkel cell carcinoma (MCC) is an aggressive skin malignancy with rising incidence. Prior studies suggest sociodemographic factors influence outcomes, but data in the immunotherapy era are limited. This study evaluates the association between sociodemographic characteristics and MCC presentation, treatment, and survival in the immunotherapy era. We conducted a retrospective population-based cohort study using National Cancer Database data from 2016 to 2020 to evaluate associations between sociodemographic factors, disease presentation, treatment, and survival in MCC during the immunotherapy era. We observed differences in presentation, treatment, and outcomes by race, insurance status, and socioeconomic status. Black patients had 1.52-fold higher odds of presenting with stage II disease (95% CI 1.09–2.12) and 1.41-fold higher odds of stage III/IV disease (95% CI 1.25–1.59) compared to White patients, along with longer median treatment delays (25.5 vs. 19.7 days, p < 0.05). Shorter time-to-treatment was independently associated with improved survival (HR 0.89; 95% CI 0.83–0.95). Overall treatment rates were high (97.41%), but uninsured patients had higher amputation rates (1.47% vs. 0.37%, p < 0.001) and were twice as likely to receive no treatment (5.88% vs. 3.13%, p < 0.001) versus privately insured patients. Five-year survival differed across SES quartiles (45.99% vs. 55.09% for lowest vs. highest, p < 0.001). In multivariable analysis adjusting for age, sex, stage, comorbidity, and treatment, only SES remained an independent predictor of survival, with the highest quartile showing a 17% lower mortality risk (adj-HR 0.83; 95% CI 0.71–0.96). In conclusion, SES was the strongest independent predictor of survival (adj-HR 0.83 for highest vs. lowest quartile) in this national MCC cohort, with additional differences by race, insurance, and geography in disease presentation and treatment patterns. These findings highlight the importance of considering sociodemographic factors in managing MCC in the immunotherapy era.