Journal Article

DKFZ-2026-01013

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png General health versus tumor stage: determinants of survival in Merkel cell carcinoma assessed by sentinel lymph node biopsy.

Gambichler, T. ; Heinzer, E. ; Rached, N. A. ; Schulze, H.-J. ; Noah, K. ; Hofmann, S. C. ; Wesselmann, U. ; Gutzmer, R. ; Boms, S. ; Susok, L. ; Weyer-Fahlbusch, S. S. ; Kreuter, A. ; Hyun, J. ; Müller, V. L. ; Auer, R. ; Becker, J.DKFZ*

2026
Springer Heidelberg

Abstract: Purpose: Overall survival (OS) of Merkel cell carcinoma (MCC) patients is strongly influenced by health. Sentinel lymphnode biopsy (SLNB) is recommended for staging. We evaluated whether SLNB is associated with OS in clinically nodenegative MCC and contrasted tumor factors with patient frailty.Methods: STROBE-compliant cohort across eight centers in Germany (2004–2024). We included 271 primary stage I–IIMCC; 167 underwent SLNB and 104 did not. The primary outcome was OS; disease-specific survival (DSS) and progres‑sion-free probability (PFP) were secondary. Kaplan–Meier and Cox models were used. Confounding by indication wasaddressed with 1:1 propensity score matching and sensitivity analyses.Results: Patients receiving SLNB were younger (median 74 vs 82 years; p < 0.001) and less comorbid (Charlson 4 vs 5). Tenyear OS was 69.5% with SLNB versus 45.2% without (log-rank p<0.0001); unadjusted HR 0.34 (95% CI 0.20–0.59). In thematched cohort, SLNB remained associated with lower all-cause mortality (HR 0.56, 95% CI 0.34–0.93; p=0.024). DSS didnot differ (HR 1.09, 95% CI 0.55–2.13; p=0.81). For PFP, unadjusted curves favored SLNB (p=0.0045), but the matchedanalysis was not significant (HR 0.53, 95% CI 0.23–1.26). Sensitivity analyses suggested benefit: overlap weighting HR 0.49(95% CI 0.33–0.73; p=0.00045) and a stage-restricted match HR 0.36 (95% CI 0.13–0.99; p=0.048).Conclusions: SLNB was associated with improved OS after adjustment, supporting its role in staging and risk stratification.The absence of DSS and matched PFP differences highlights the influence of overall health; residual confounding by indica‑tion cannot be excluded.

Keyword(s): Cancer ; Elderly ; Performance status ; Prognosis

Note: #DKTKZFB26#

---

Contributing Institute(s):

1. DKTK Koordinierungsstelle Essen/Düsseldorf (ED01)
2. DKTK ED Translationale Hautkrebsforschung (ED03)

Research Program(s):

1. 899 - ohne Topic (POF4-899) (POF4-899)

Appears in the scientific report 2026

---

Database coverage:
; ; ; Article Processing Charges ; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Life Sciences ; DEAL Springer ; DOAJ Seal ; Ebsco Academic Search ; Essential Science Indicators ; Fees ; IF < 5 ; JCR ; PubMed Central ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

---