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Positive Lymph Nodes in Adrenocortical Carcinoma: What Does It Mean?

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Abstract

Background

The role of lymphadenectomy in adrenocortical carcinoma resection is controversial. Therefore, we conducted a population-based study to assess the association between positive lymph nodes (LN) and survival.

Methods

The Surveillance, Epidemiology, and End Results set of cancer registries were utilized. The associations between positive lymph nodes and tumor size, grade and laterality were assessed. Cancer specific survival (CSS) trends and factors affecting survival were analyzed.

Results

A total of 2170 adult patients were identified; 60% underwent resection. Among those resected, LN were examined in 23% and were positive in 25% of patients with LN examined. Patients with positive LN tended to have smaller tumors compared to those with negative LN (12 ± 5 vs 15 ± 11 cm, p = 0.02). The rate of positive LN was higher in right ACC, p = 0.03. Median overall CSS was 21 months, with significant differences between resection (42 months) and no resection (4 months), p < 0.01. Median CSS did not change over time when comparing ACC patients who underwent surgery before 2000, 2000–2009, and 2010–2016. On multivariable analysis including resection group, advanced age, grades III and IV, regional and distant stage, in addition to positive LN were associated with worse survival, p < 0.05.

Conclusion

Lymphadenectomy is infrequently performed during ACC resection, and when performed, regional LN involvement tends to be associated with worse survival. Neoplasm size and grade were not associated with LN involvement and therefore, do not inform lymphadenectomy need. Further studies are needed to assess the indications for, and value of lymphadenectomy in ACC.

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Acknowledgements

This publication was made possible by CTSA Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Alaa Sada, Melanie L. Lyden, Geoffrey B. Thompson, Benzon M. Dy, Travis J. McKenzie & Elizabeth B. Habermann

  2. Surgical Outcomes Program, Robert D and Patricia E Kern Center for The Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Amy E. Glasgow & Elizabeth B. Habermann

Authors
  1. Alaa Sada
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  2. Amy E. Glasgow
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  3. Melanie L. Lyden
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  4. Geoffrey B. Thompson
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  5. Benzon M. Dy
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  6. Travis J. McKenzie
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  7. Elizabeth B. Habermann
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Contributions

Study conception and design: AS, AG, EH, TM. Acquisition of data: AS, AG. Analysis and interpretation of data: AS, AG, EH, TM, GT, BD, ML. Drafting of manuscript: AS, AG, EH, TM, GT, BD, ML. Critical Revision of manuscript: AS, AG, EH, TM, GT, BD, ML.

Corresponding author

Correspondence to Elizabeth B. Habermann.

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Appendix

Appendix

See Table 4.

Table 4 Surgical groups
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Sada, A., Glasgow, A.E., Lyden, M.L. et al. Positive Lymph Nodes in Adrenocortical Carcinoma: What Does It Mean?. World J Surg 45, 188–194 (2021). https://doi.org/10.1007/s00268-020-05801-x

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  • DOI: https://doi.org/10.1007/s00268-020-05801-x

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