PD07-08: Association of Tumor Size and Surgical Approach with Oncological Outcomes in Patients with Adrenocortical Carcinoma

Friday, September 10, 2021 4:30 PM to 6:30 PM
Abstract

Information

Authors: Kevin Ginsburg, David Perlman, Alberto Andres Castro Bigalli, Elizabeth Handorf, Jared Schober, David Chen, Richard Greenberg, Rosalia Viterbo, Robert Uzzo, Alexander Kutikov, Marc Smaldone, Andres Correa

Introduction: The European Society of Endocrinology and European Network for the Study of Adrenal Tumors recommends that adrenal lesions concerning for adrenocortical carcinoma (ACC) larger than 6 cm in size undergo open adrenalectomy (OA). We investigated the oncological outcomes for patients with masses =6 cm and >6 cm in size treated with minimally invasive adrenalectomy (MIA) compared with OA.

Methods: We reviewed the National Cancer Database for patients undergoing adrenalectomy for cT1-3N0M0 ACC from 2010 to 2017. We fit multivariable models with an interaction term between tumor size and surgical approach. The linear combination of regression coefficients was used to estimate the adjusted HR and OR for oncological outcomes for patients treated with MIA compared with OA. Outcomes of interest were overall survival (OS), receipt of adjuvant treatment (radiation and/or system therapy), and positive surgical margins (PSM). Models were adjusted for clinical T-stage, age, race, sex, comorbidity score, and insurance type.

Results: We identified 785 patients treated with adrenalectomy, of which 309 had a minimally invasive surgery. For patients with masses =6 cm in size, we did not appreciate a difference in OS (HR 1.00, 95% CI: 0.62-1.60, p=0.985), use of adjuvant treatment (OR 0.81, 95% CI 0.42-1.55, p=0.526), or PSM (OR 1.42, 95% CI 0.86-2.34, p=0.173) between patients treated with MIA compared with OA. For patients with masses >6 cm in size, we did not appreciate a difference in OS (HR 1.24, 95% CI 0.96-1.60, p=0.103), receipt of adjuvant treatment (OR 0.92, 95% CI 0.63-1.35, p=0.680), or PSM (OR 1.42, 95% CI 0.86-2.34, p=0.173) between patients treated with MIA compared with OA. Utilizing size thresholds of >4, >5, >6, >7, >8, >9, or >10 cm in size, we did not identify a threshold associated with worse OS, receipt of adjuvant treatments, or PSM when treated with MIA vs. OA (Table 1).

Conclusions: Patients with ACC tumors =6 cm and >6 cm in size had similar OS, adjuvant treatments, and PSM when treated with MIA compared with OA. OA remains the standard of care for patients undergoing adrenalectomy for ACC but these data suggest future investigations are needed to help inform guideline statements regarding the appropriate use of MIA vs. OA.

Source of Funding: None

Therapeutic Area
Oncology: Adrenal/Kidney