Treatment Patterns and Survival Outcomes of Head and Neck Merkel Cell Carcinoma: An Age-Stratified Analysis.

BACKGROUND

H&N Merkel cell carcinoma (MCC) mainly affects elderly patients, yet age-stratified treatment patterns and outcomes data are scarce.

METHODS

We analyzed 88 consecutive H&N MCC patients (2000-2022) by age (< 75 vs. ≥ 75 years). OS was estimated by Kaplan-Meier analysis and MCC-specific death with competing-risks methods (cause-specific Cox regression).

RESULTS

Of 88 patients, 57% were ≥ 75 years; older patients underwent less surgery but received RT at similar rates. Age ≥ 75 dominated OS (5-year 23% vs. 71%; adjusted HR 3.24). The 5-year cumulative incidence of MCC-specific death was higher in older patients (42% vs. 23%) but was not independent after adjustment (cause-specific HR 2.02, p = 0.10); competing non-MCC mortality was far higher (31% vs. 6%). Six of 11 ICI-treated patients (55%) were alive at 1.9 years.

CONCLUSIONS

Elderly patients undergo less surgery yet receive equivalent RT. Age dominates overall survival, but this mainly reflects competing non-MCC mortality rather than a cancer-specific effect; age-tailored, competing-risk-aware protocols are needed.