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Adrenocortical carcinoma in the United States: Treatment utilization and prognostic factors
Abstract
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare tumor with a relatively poor prognosis. The authors' objectives were to examine treatment utilization and factors associated with long-term survival after resection of ACC in a large, national, patient population. METHODS: Patients diagnosed with ACC from 1985 to 2005 were identified from the National Cancer Data Base (NCDB). Patient, tumor, treatment, and hospital factors associated with survival after resection were examined. RESULTS: For the current study, 3982 patients with ACC were identified. Median age at diagnosis was 55 years. Median tumor size was 13 cm. Of the patients with nodes examined, 26.5% had nodal metastases. Distant metastases were found on presentation in 21.6% of patients. A total of 57.4% of patients underwent surgical resection alone, whereas 16.0% underwent resection with adjuvant chemotherapy or radiation. A total of 19.4% had margin-positive resections. Treatment utilization remained unchanged from 1985 to 2005 (P = .28). Median follow-up was 24 months. Overall 5-year survival for all patients who underwent resection was 38.6% (median survival, 31.9 months). Multivariable analysis demonstrated a higher risk of death with increasing age, poorly differentiated tumors, involved margins, and nodal or distant metastases. Overall survival remained unchanged from 1985 to 2000 (P = .08). CONCLUSIONS: ACC carries a poor prognosis for patients commonly presenting with large, locally invasive tumors, involved margins, and metastatic disease. Survival is not affected by size but is diminished with increasing age, poorly differentiated tumors, involved margins, and the presence of regional and distant disease. Identification of novel therapies may help to increase survival, which has remained unchanged over the last 20 years.
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“Analysis of the SEER database gives a slightly older mean age of 55 years (11).”
From Adrenocortical carcinoma (2014) · cites this paper as [11]
In the citing paper
“However, in the United States, 45% of adrenalectomies for ACC are performed in community hospitals, 30% in academic centers, and only 15% in National Cancer Institute-designated Cancer Centers, suboptimal treatment of a rare and aggressive disease requiring specialized knowledge of surgical technique (11).”
From Adrenocortical carcinoma (2014) · cites this paper as [11]
In the citing paper
“an analysis of almost 4000 patients from the National Cancer Data Base, which found that 9% of ACC patients treated with surgery had microscopically positive margins (R1), whereas a further 10% had macroscopically positive margins (R2) (11).”
From Adrenocortical carcinoma (2014) · cites this paper as [11]
In the citing paper
“The outcomes after surgical resection alone have remained suboptimal (11, 244, 267, 269–273).”
From Adrenocortical carcinoma (2014) · cites this paper as [11]
In the citing paper
“patients with positive margins had a dismal prognosis compared with those with uninvolved margins; 5-year survival was 10% after R2 resection, 21% after R1, and 49% after R0 (11).”
From Adrenocortical carcinoma (2014) · cites this paper as [11]
In the citing paper
“ACC has a well-documented propensity for lymphatic dissemination (11, 91, 351), with involved nodal disease in approximately 15% to 27% of patients at the time of surgery (11, 91).”
From Adrenocortical carcinoma (2014) · cites this paper as [11]
In the citing paper
“In the United States, it is used in approximately 10% of cases, according to analyses of both the National Cancer Data Base and the SEER program (4, 11, 90).”
From Adrenocortical carcinoma (2014) · cites this paper as [11]
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Metadata
- Authors
- Bilimoria, K. Y., Shen, W. T., Elaraj, D., Bentrem, D. J., Winchester, D. J., Kebebew, E., & Sturgeon, C.
- Affiliations
- Northwestern University (US)
- University of California, San Francisco (US)
- Corresponding author
- Bilimoria, Karl Y.
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2008-10-30
- Volume
- 113
- Issue
- 11
- Pages
- 3130-3136
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- OpenAlex
- W1994325777
- Cited by
- 493
- References
- 22
- Citations by year
- 2026: 17 · 2025: 24 · 2024: 29 · 2023: 28 · 2022: 28 · 2021: 45 · 2020: 39 · 2019: 29 · 2018: 39 · 2017: 31 · 2016: 26 · 2015: 35 · 2014: 24 · 2013: 19 · 2012: 29
- FWCI
- 17.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cancer (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Oncology › Renal cell carcinoma treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- adrenocortical carcinoma, adrenalectomy, surgical resection, long-term survival, prognostic factors, tumor differentiation, positive resection margins, lymph node metastasis, distant metastasis, adjuvant chemotherapy, adjuvant radiotherapy, treatment utilization, age at diagnosis
- MeSH terms
- Adrenal Cortex Neoplasms, Adult, Aged, Female, Humans, Male, Middle Aged, Prognosis, Registries, United States, Survival Analysis, Treatment Outcome, Adrenocortical Carcinoma, Disease-Free Survival
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