Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3509–3514 | Cite as

Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States

  • Lauren Gratian
  • John Pura
  • Michaela Dinan
  • Shelby Reed
  • Randall Scheri
  • Sanziana Roman
  • Julie Ann Sosa
Endocrine Tumors

Abstract

Background

Adrenocortical carcinoma (ACC) is a rare, aggressive disease with no apparent change in treatment or survival in the United States over the past two decades. Our objective was to determine whether treatment patterns or clinical outcomes vary by hospital case volume.

Methods

Patients with ACC were identified from the National Cancer Database (1998–2011). High-volume centers (HVCs) were defined by a case load of ≥4 cases of primary adrenal malignancy annually, which corresponded to the 90th percentile. All other facilities were considered low-volume centers (LVCs).

Results

A total of 2,765 ACC patients were treated across 1,046 facilities. Compared to patients treated at LVCs, patients treated at HVCs were younger (50 vs. 54 years), with larger tumors (11.2 vs. 10.5 cm), and underwent higher rates of surgery (78.8 vs. 73.4 %), radical resection (17.3 vs. 13.9 %), regional lymph node evaluation (23.2 vs. 18.8 %), and chemotherapy including mitotane (43.8 vs. 31.0 %, all p < 0.05).There were no significant differences in median length of stay (5 vs. 5 days), 30-day readmission rates (4.0 % for HVCs vs. 3.9 % for LVCs), or 30-day postoperative mortality rates (1.9 % for HVCs vs. 3.7 % for LVCs). Median overall survival was 2.0 years for HVCs and 1.9 years for LVCs, p = 0.53. After adjusting for patient and tumor characteristics, overall survival did not differ significantly between patients treated at HVCs versus LVCs [HR = 0.89 (95 % confidence interval 0.70, 1.12)].

Conclusions

Treatment at HVCs was associated with more aggressive surgical resection and chemotherapy use. Prognosis remained poor despite more aggressive treatment.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Lauren Gratian
    • 1
  • John Pura
    • 2
  • Michaela Dinan
    • 3
  • Shelby Reed
    • 3
  • Randall Scheri
    • 4
  • Sanziana Roman
    • 4
  • Julie Ann Sosa
    • 3
    • 4
  1. 1.Division of Endocrinology, Department of MedicineDuke University School of MedicineDurhamUSA
  2. 2.Department of BiostatisticsDuke University School of MedicineDurhamUSA
  3. 3.Duke Clinical Research InstituteDurhamUSA
  4. 4.Section of Endocrine Surgery, Department of SurgeryDuke University School of MedicineDurhamUSA

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