Skip to main content
SpringerLink
Log in

Does Lymphadenectomy Improve Survival in Patients with Adrenocortical Carcinoma? A Population-Based Study

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

A recent study suggested a survival benefit in patients with adrenocortical carcinoma (ACC) who had undergone lymphadenectomy. The objective of this study was to study the effect of lymphadenectomy on the survival rates of patients with ACC.

Methods

Data from adult patients with histology-proven ACC from the National Cancer Institute’s Surveillance, Epidemiology, and End Results 18 Registries (1973–2011) were analyzed to assess the impact of lymphadenectomy (≥4 lymph nodes removed) on disease-specific survival (DSS).

Results

Of 1525 patients with ACC, 45 % were male. 36, 20, and 44 % of patients presented with localized, regional, and distant metastatic diseases, respectively. 8 % of patients (n = 67/802) underwent lymphadenectomy. We observed a higher rate of lymphadenectomy performed in patients with regional disease [locally advanced tumors (stage T3 and T4) and/or lymph node metastasis] and distant metastasis than in those with localized tumors (12.4 % and 12.0 vs. 5.1, respectively, p < 0.01) and in patients with primary tumor sizes >10 cm (12.4 vs. 4.2 %, p < 0.01). Lymph node metastasis was present in 12.8 % (19.2 % in locally advanced ACC). A lymphadenectomy was not associated with improved DSS on univariate analysis (p = 0.30), regardless of tumor size or staging. Independent prognostic factors included: ages ≥60 years (p < 0.01, HR 1.70), lymph node metastasis (p < 0.01, HR 1.7), distant metastasis (p < 0.01, HR 5.6), complete resection of tumor (p < 0.01, HR 0.47), and debulking surgery (p < 0.01, HR 0.49).

Conclusion

A lymphadenectomy is not commonly performed in patients with ACC in the U.S. Although we found no survival benefit in this cohort with a low rate of lymphadenectomy, a lymphadenectomy may be considered in patients with locally advanced tumors (T3 and T4) due to a higher rate of lymph node metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Allolio B, Fassnacht M (2006) Clinical review: adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab 91:2027–2037

    Article  CAS  PubMed  Google Scholar 

  2. Dackiw AP, Lee JE, Gagel RF et al (2001) Adrenal cortical carcinoma. World J Surg 25:914–926. doi:10.1007/s00268-001-0030-7

    Article  CAS  PubMed  Google Scholar 

  3. Fassnacht M, Kroiss M, Allolio B (2013) Update in adrenocortical carcinoma. J Clin Endocrinol Metab 98:4551–4564

    Article  CAS  PubMed  Google Scholar 

  4. Schulick RD, Brennan MF (1999) Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol 6:719–726

    Article  CAS  PubMed  Google Scholar 

  5. Fassnacht M, Johanssen S, Fenske W et al (2010) Improved survival in patients with stage II adrenocortical carcinoma followed up prospectively by specialized centers. J Clin Endocrinol Metab 95:4925–4932

    Article  CAS  PubMed  Google Scholar 

  6. Bourdeau I, MacKenzie-Feder J, Lacroix A (2013) Recent advances in adrenocortical carcinoma in adults. Curr Opin Endocrinol Diabetes Obes 20:192–197

    Article  CAS  PubMed  Google Scholar 

  7. Gaujoux S, Brennan MF (2012) Recommendation for standardized surgical management of primary adrenocortical carcinoma. Surgery 152:123–132

    Article  PubMed  Google Scholar 

  8. Mocellin S, Nitti D (2015) Lymphadenectomy extent and survival of patients with gastric carcinoma: a systematic review and meta-analysis of time-to-event data from randomized trials. Cancer Treat Rev 41:448–454

    Article  PubMed  Google Scholar 

  9. Barrisford GW, Gershman B, Blute ML Sr (2014) The role of lymphadenectomy in the management of renal cell carcinoma. World J Urol 32:643–649

    Article  PubMed  Google Scholar 

  10. Stephenson AJ, Bosl GJ, Motzer RJ et al (2005) Retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer: impact of patient selection factors on outcome. J Clin Oncol 23:2781–2788

    Article  PubMed  Google Scholar 

  11. Reibetanz J, Jurowich C, Erdogan I et al (2012) Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma. Ann Surg 255:363–369

    Article  PubMed  Google Scholar 

  12. National Cancer Institute, U.S. National Institutes of Health (2012). Surveillance Epidemiology and End Results: ICD-O-3 Coding Materials. http://seer.cancer.gov/icd-o-3/

  13. Office of Management and Budget (2003). Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. http://www.whitehouse.gov/omb/fedreg_1997standards/. Accessed 21 May 2012

  14. Fisher RA (1922) On the Interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc 85:87–94

    Article  Google Scholar 

  15. Mann HB, Whiteney DR (1947) On a test of whether one of two random variables is stochastically larger than the other. Ann Math Stat 18:50–60

    Article  Google Scholar 

  16. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  17. Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50:163–170

    CAS  PubMed  Google Scholar 

  18. Cox DR (1972) Regression models and life tables. J R Stat Soc B 34:187–220

    Google Scholar 

  19. Aufforth RD, Nilubol N (2014) Emerging therapy for adrenocortical carcinoma. Int J Endocr Oncol 1:173–182

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Asare EA, Wang TS, Winchester DP et al (2014) A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease. Surgery 156:1378–1385 discussion 1385–1376

    Article  PubMed  Google Scholar 

  21. Bilimoria KY, Shen WT, Elaraj D et al (2008) Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer 113:3130–3136

    Article  PubMed  Google Scholar 

  22. Miller BS, Doherty GM (2013) Regional lymphadenectomy for adrenocortical carcinoma. Ann Surg 257:e13–e14

    Article  PubMed  Google Scholar 

  23. Tran TB, Liou D, Menon VG et al (2013) Surgical management of advanced adrenocortical carcinoma: a 21-year population-based analysis. Am Surg 79:1115–1118

    PubMed  Google Scholar 

  24. Saade N, Sadler C, Goldfarb M (2015) Impact of regional lymph node dissection on disease specific survival in adrenal cortical carcinoma. Horm Metab Res. doi:10.1055/s-0035-1549877

    PubMed  Google Scholar 

  25. Papotti M, Libe R, Duregon E et al (2011) The Weiss score and beyond—histopathology for adrenocortical carcinoma. Horm Cancer 2:333–340

    Article  CAS  PubMed  Google Scholar 

  26. Livhits M, Li N, Yeh MW et al (2014) Surgery is associated with improved survival for adrenocortical cancer, even in metastatic disease. Surgery 156:1531–1540 discussion 1540-1531

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Rm. 3-5840, Bethesda, MD, 20892, USA

    Naris Nilubol, Dhaval Patel & Electron Kebebew

Authors
  1. Naris Nilubol
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dhaval Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Electron Kebebew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naris Nilubol.

Ethics declarations

Disclosure

The authors have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nilubol, N., Patel, D. & Kebebew, E. Does Lymphadenectomy Improve Survival in Patients with Adrenocortical Carcinoma? A Population-Based Study. World J Surg 40, 697–705 (2016). https://doi.org/10.1007/s00268-015-3283-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-3283-2

Keywords

Search

Navigation