The association between facility volume and overall survival in patients with Merkel cell carcinoma

J Surg Oncol. 2020 Aug;122(2):254-262. doi: 10.1002/jso.25931. Epub 2020 Apr 15.


Background: Merkel cell carcinoma is an uncommon malignancy often requiring multidisciplinary management. The purpose of this study was to determine whether high-volume facilities have improved outcomes in patients with Merkel cell carcinoma relative to lower-volume facilities.

Methods: A total of 5304 patients from the National Cancer Database with stage I-III Merkel cell carcinoma undergoing surgery were analyzed. High-volume facilities were the top 1% by case volume. Multivariable Cox regression and propensity score-matching were performed to account for imbalances between groups.

Results: Treatment at high-volume facilities (hazard ratio: 0.74; 95% confidence interval: 0.65-0.84, P < .001) was independently associated with improved overall survival (OS) in multivariable analyses. In propensity score-matched cohorts, 5-year OS was 62.3% at high-volume facilities vs 56.8% at lower-volume facilities (P < .001). Median OS was 111 months at high-volume facilities vs 79 months at lower-volume facilities.

Conclusion: Treatment at high-volume facilities is associated with improved OS in Merkel cell carcinoma. Given the impracticality of referring all elderly patients with Merkel cell carcinoma to a small number of facilities, methods to mitigate this disparity should be explored.

Keywords: Merkel cell carcinoma; facility characteristics; high-volume facilities.

MeSH terms

  • Aged
  • Cancer Care Facilities / statistics & numerical data
  • Carcinoma, Merkel Cell / mortality*
  • Carcinoma, Merkel Cell / pathology
  • Carcinoma, Merkel Cell / surgery*
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Neoplasm Staging
  • Propensity Score
  • Proportional Hazards Models
  • Skin Neoplasms / mortality*
  • Skin Neoplasms / pathology
  • Skin Neoplasms / surgery*
  • Survival Rate
  • United States / epidemiology