Association of Surgical Approach With Treatment Burden,Oncological Effectiveness,and Perioperative Morbidity in Adrenocortical Carcinoma |
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| Institution: | 1. Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA;2. Wayne State University Department of Urology, Detroit, MI;3. Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia PA;1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC;2. Lineberger Comprehensive Cancer Center (LCCC), UNC-CH, Chapel Hill, NC, USA;3. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA;4. Department of Chronic Disease Epidemiology, Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA;5. Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA;6. Department of Population Health Sciences, Duke University School of Medicine (DUSM), Durham, NC, USA;7. Duke Cancer Institute (DCI) Center for Prostate and Urologic Cancers, Durham, NC, USA;8. Department of Medicine, DUSM, Durham, NC, USA;9. Department of Surgery (Urology), DUSM, Durham, NC, USA;10. Duke Cancer Institute (DCI), DUSM, Durham, NC, USA;11. Department of Urology, Yale School of Medicine, New Haven, CT, USA;12. Department of Medicine, Yale School of Medicine, New Haven, CT, USA;1. Department of Urology, Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, UK;2. Urology Centre, Guy''s Hospital, Guys and St Thomas'' NHS Foundation Trust, Great Maze Pond, London, UK;3. Department of Urology, Salisbury District Hospital, Salisbury NHS Foundation Trust, Salisbury, UK;4. Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany;1. Gustave Roussy, Département de Médecine Oncologique, University of Paris Saclay, Villejuif, France;2. Centre Léon Bérard, Lyon, France;3. Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée—Ligue Nationale contre le Cancer, Villejuif, France;4. Université Paris-Saclay, Ile-de-France, France;5. IUCT-Oncopôle Institut Claudius Regaud, Toulouse, France;6. Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France;7. Hôpital Européen Georges Pompidou, AP-HP, University of Paris, Paris, France;8. Centre Eugene Marquis, Rennes, France;9. Institut Cancérologie Strasbourg Europe, Strasbourg, France;10. Bordeaux University Hospital, Bordeaux, France;11. Centre Alexis Vautrin, Vandoeuvre-Lès-Nancy, France;12. Institut de Cancérologie de l''Ouest, Department of Medical Oncology, St Herblain, France;13. University Hospital Jean Minjoz, Besançon, France;14. Centre François Baclesse, Caen, France;15. Georges-François Leclerc Cancer Center, Dijon, France;16. UNICANCER, Le Kremlin-Bicêtre, France;1. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Urology, IRCCS Policlinico San Martino, Genova, Italy;4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;5. Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy;6. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;7. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;9. Departments of Urology, Weill Cornell Medical College, New York, NY;10. Department of Urology, University of Texas Southwestern, Dallas, TX;11. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic;12. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;13. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan;1. Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico \"Don Tonino Bello,\" I.R.C.C.S. Istituto Tumori \"Giovanni Paolo II,\" Bari, Italy;2. Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy;3. Oncology Unit, Macerata Hospital, Macerata, Italy;4. Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy;1. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;2. Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen Denmark;3. International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) University of Copenhagen, Copenhagen, Denmark;4. Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;5. Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark;6. Centre of Physical Activity Research, Centre of Inflammation and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;7. Statistics and Data analysis, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark |
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| Abstract: | MicroabstractIn the National Cancer Database (NCDB), patients treated with minimally invasive adrenalectomy (MIA) for adrenocortical carcinoma (ACC) had similar oncological outcomes and cumulative treatment burden with less morbidity compared with open adrenalectomy (OA). Although OA remains the standard of care for adrenal lesions concerninge for malignancy, MIA in appropriately selected patients may offer equivalent oncological outcomes.Introduction/BackgroundWe investigated the cumulative treatment burden, oncological effectiveness, and perioperative morbidity in patients undergoing MIA compared with (OA) for patients with ACC.Patients and MethodsWe reviewed the NCDB for patients undergoing surgical resection (MIA vs. OA) for ACC from 2010 to 2017. Inverse probability of treatment weighted logistic regression, negative binomial, and Cox proportional hazards models were fit to assess for an association of surgical approach with cumulative treatment burden (any adjuvant therapy, radiation therapy RT], and systemic therapy), oncological effectiveness (positive surgical margins PSM], lymph node yield LNY], and overall survival OS]), and perioperative morbidity (length of stay LOS] and readmission) as appropriate.ResultsWe identified 776 patients that underwent adrenalectomy for ACC, of which 307 underwent MIA. We noted patients with larger tumors (OR 0.82, 95% CI 0.78-0.86, P < .001) were less likely to have MIA prior to IPTW. We did not appreciate a significant association of MIA with cumulative treatment burden or the use of any adjuvant therapy (OR 0.85, 95% CI 0.60-1.21, P = .375), adjuvant RT (OR 0.94, 95% CI 0.59-1.50, P = .801), or adjuvant systemic therapy (OR 0.84, 95% CI 0.58-1.21, P = .352). Patients undergoing MIA had similar oncological effectiveness of surgery and OS when compared with patients which underwent OA. Patients that underwent MIA had a significantly shorter LOS (IRR: 0.74, 95% CI 0.62-0.88, P = .001) and lower odds of readmission (OR 0.46, 95% CI 0.23-0.91, P = .026).ConclusionsAlthough the standard of care for adrenal lesions suspicious for ACC remains OA, in appropriately selected patients, MIA may offer similar oncological effectiveness and cumulative treatment burden, with less morbidity, than OA. |
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