MERKEL CELL CARCINOMA OF EXTREMITIES: COMPARISON WITH OTHER BODY SITES TREATED BY RADIOTHERAPY WITH AN AGGREGATED 949-PATIENT DATABASE
Bibliographic record
Abstract
Merkel Cell carcinoma is an aggressive cutaneous neoplasm. We studied the management and outcomes of lesions located in the extremities to analyze if peripheral MCC behaves similarly to the rest of the body. A 949-patient aggregated database built from records of six international cancer institutions and publications obtained from a PubMed search during the period (March 1982 - February 2015, consisting of patient characteristics, treatment details and outcomes. Equivalent doses in 2 Gy fractions were calculated for the study cohort using linear-quadratic formula. We evaluated pattern of locoregional recurrence, cause-specific (CSS) and overall survival (OS) between the extremity versus head and neck or trunk subgroups by log-rank tests. 942/949 patients were adequate for analysis, with primaries in the head and neck 453/942 (48.1%), limb 355/942 (37.7%) and trunk 100/942 (10.6%). For limb primaries, 273/355 (76.9%) were clinical Stage I or II/localized, 64/355 (18.0%) Stage III/nodal disease, 9/355 (2.5%) Stage IV/distant metastases and 8/355 (2.3%) unknown stage. Radiotherapy techniques include: no RT 236/355 (66.5%), primary site only 33/355 (9.3%) with a median dose of 50 (range: 28-68.7) Gy2 or local+nodal coverage 35/355 (9.9%) with a median dose of 50 (range: 37.3-60.0) Gy2. 343 patients had known outcome: local recurrence 74/343 (21.6%), nodal recurrence 175/343 (51.0%) and distant recurrence 108/343 (31.5%). The 5-year OS of limb subgroup was 45.4%, versus trunk subgroup (24.5%, P=0.005); corresponding 5-year CSS were 60.0% versus 34.2% (P=0.000015). 5-year OS for limb versus head and neck were 45.4% versus 35.5% (P=0.0027) and CSS (60.0% versus 58.2%, P=0.37). MCC in the extremities have significantly better OS than truncal or head and neck sites. Future prospective data using various treatments including combination immunotherapy/surgery/ radiotherapy will provide more insight into the management and outcomes of these patient subgroups.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.010 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".