Identification of oncological characteristics associated with improved overall survival in patients with adrenocortical carcinoma treated with adjuvant radiation therapy: Insights from the National Cancer Database

Kevin B. Ginsburg, Akhil A. Chandra, Jared P. Schober, Elizabeth A. Handorf, Robert G. Uzzo, Richard E. Greenberg, David YT Chen, Rosalia Viterbo, Marc C. Smaldone, Alexander Kutikov, Mark A. Hallman, Andres F. Correa

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objectives: To test for an association between oncological risk factors and overall survival in patients with non-metastatic adrenocortical carcinoma treated with adjuvant radiation therapy at high-risk for recurrence per NCCN guidelines. Materials and Methods: We analyzed data from patients undergoing surgical resection with or without aRT in the NCDB from 2004 to 2017. A multivariable Cox proportional hazards model was fit to assess for an association of aRT and OS. To determine whether aRT was associated with improved OS in patients with specific NCCN risk factors, we fit three multivariable Cox proportional hazard models with an interaction term between NCCN risk factors and the use of aRT. Results: We identified 1,433 patients treated surgically for adrenocortical carcinoma with at least one risk factor. 259 patients received adjuvant radiation therapy (18%) while 1,174 (82%) patients did not. After adjustment, we noted a significant association between adjuvant radiation therapy and overall survival in the entire cohort in the multivariable Cox proportional hazards model (HR 0.68, 95% CI 0.55–0.85, P = 0.001). Adjuvant radiation therapy was associated with increased overall survival in patients with positive surgical margins (HR 0.47, 95% CI 0.35–0.65, P < 0.001), large tumor size ≥6 cm (HR 0.69, 95% CI 0.55–0.87, P = 0.002), and high-grade disease (HR 0.61, 95% CI 0.37–0.99, P = 0.046). Conclusions: Patients with ACC at high-risk for recurrence were associated with improved overall survival when treated with adjuvant radiation therapy. These data may help identify which patients should consider aRT after resection of clinically localized ACC.

Original languageEnglish (US)
Pages (from-to)791.e1-791.e7
JournalUrologic Oncology: Seminars and Original Investigations
Volume39
Issue number11
DOIs
StatePublished - Nov 2021
Externally publishedYes

Keywords

  • Adrenocortical carcinoma
  • Margin positive
  • Overall survival
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Urology

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