Sina Furnes Øyri, Siri Wiig, Ole Tjomsland
Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons' perspectives
BMJ open quality
merkel cell carcinoma mcc comprises rare malignant primary skin tumor presenting neuroendocrine differentiation recently agents blocking programmed cell death protein 1 programmed cell death protein ligand 1 pathway pd1pdl1 demonstrated objective durable tumor regressions patients presenting advanced mcc study aimed describe sociodemographic clinical histopathological characteristics mcc patients also assessing prevalence pdl1 expression merkel cell polyomavirus mcpyv well prognostic roles data patients diagnosed mcc 1996 2019 reference cancer center rio de janeiro southeastern brazil evaluated retrospective study tumor samples tested mcpyv pdl1 employing immunohistochemistry survival analyses carried employing kaplanmeier method curves compared using logrank test multiple semiparametric cox model used values p 005 considered significant total 65 patients included study mean age diagnosis 72 standard deviation 139 total 569 3765 patients male 862 5665 white 569 3764 illiterate incomplete elementary school mcpyv immunohistochemistry positive 29 cases 446 pdl1 positivity 1 42 cases 646 significant associations mcpyv pdl1 expression 1 p 0003 pdl1 expression 5 p 0005 noted concerning multivariate analysis education level advanced mcc stage indicated statistically significant worse progressionfree survival regarding overall survival os male education level advanced stage comprised risk factors estimated os 60 months stages iii 489 stage iv 89 first large brazilian cohort assess prevalence mcpyv mcc tumors well pdl1 expression associations correlations noted mcpyv infection pdl1 expression survival rates