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Defining Optimal Management of Non-metastatic Adrenocortical Carcinoma

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Adrenocortical carcinoma (ACC) is an aggressive, deadly malignancy. Resection remains the primary treatment; however, there is conflicting evidence regarding the optimal approach to and extent of surgery and the role of adjuvant therapy. We evaluated the impact of surgical technique and adjuvant therapies on survival in non-metastatic ACC.

Methods

We performed a retrospective cohort study of subjects who underwent surgery for non-metastatic ACC between 2010 and 2019 utilizing the National Cancer Database. The primary outcome was overall survival. Cox proportional hazards models were developed to identify associations between clinical and treatment characteristics and survival.

Results

Overall, 1175 subjects were included. Their mean age was 54 ± 15 years, and 62% of patients were female. 67% of procedures were performed via the open approach, 22% involved multi-organ resection, and 26% included lymphadenectomy. Median survival was 77.1 months. Age (hazard ratio [HR] 1.019; p < 0.001), advanced stage (stage III HR 2.421; p < 0.001), laparoscopic approach (HR 1.329; p = 0.010), and positive margins (HR 1.587; p < 0.001) were negatively associated with survival, while extent of resection (HR 1.189; p = 0.140) and lymphadenectomy (HR 1.039; p = 0.759) had no association. Stratified by stage, laparoscopic resection was only associated with worse survival in stage III disease (HR 1.548; p = 0.007). Chemoradiation was only associated with improved survival in patients with positive resection margins (HR 0.475; p = 0.004).

Conclusion

Tumor biology and surgical margins are the primary determinants of survival in non-metastatic ACC. Surgical extent and lymphadenectomy are not associated with overall survival. In advanced disease, the open approach is associated with improved survival.

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Funding

HW received funding from the National Institutes of Health, NCI grant #K08 CA270385. JMSB received funding from the NIH T32 Training Program in Surgical Oncology Research at Penn, grant #5T32CA251063-02

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Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA

    Jesse E. Passman MD, MPH, Wajid Amjad BS, Jacqueline M. Soegaard Ballester MD, MBMI, Sara P. Ginzberg MD, MS & Heather Wachtel MD

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Heather Wachtel MD

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  1. Jesse E. Passman MD, MPH
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  2. Wajid Amjad BS
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  3. Jacqueline M. Soegaard Ballester MD, MBMI
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Correspondence to Jesse E. Passman MD, MPH.

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Jesse E. Passman, Wajid Amjad, Jacqueline M. Soegaard Ballester, Sara P. Ginzberg, and Heather Wachtel declare no conflicts of interest.

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Passman, J.E., Amjad, W., Soegaard Ballester, J.M. et al. Defining Optimal Management of Non-metastatic Adrenocortical Carcinoma. Ann Surg Oncol 31, 1097–1107 (2024). https://doi.org/10.1245/s10434-023-14533-w

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