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Ginsburg KB , Chandra AA , Schober JP , Handorf EA , Uzzo RG , Greenberg RE , Chen DY , Viterbo R , Smaldone MC , Kutikov A , Hallman MA , Correa AF
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
Urol Oncol. 2021 Jul 20;39(11) :791 e1-791 e7
PMID: 34301459 URL: https://www.ncbi.nlm.nih.gov/pubmed/34301459
AbstractOBJECTIVES: 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.
Notes1873-2496 Ginsburg, Kevin B Chandra, Akhil A Schober, Jared P Handorf, Elizabeth A Uzzo, Robert G Greenberg, Richard E Chen, David Yt Viterbo, Rosalia Smaldone, Marc C Kutikov, Alexander Hallman, Mark A Correa, Andres F Journal Article United States Urol Oncol. 2021 Jul 20:S1078-1439(21)00278-7. doi: 10.1016/j.urolonc.2021.06.019.