Pd07-08 association of tumor size and surgical approach with oncological outcomes in patients with adrenocortical carcinoma

You have accessJournal of UrologyAdrenal (PD07)1 Sep 2021PD07-08 ASSOCIATION OF TUMOR SIZE AND SURGICAL APPROACH WITH ONCOLOGICAL OUTCOMES IN PATIENTS WITH ADRENOCORTICAL CARCINOMA Kevin Ginsburg, David Perlman, Alberto Andres Castro Bigalli, Elizabeth Handorf, Jared Schober, David Chen, Richard Greenberg, Rosalia Viterbo, Robert Uzzo, Alexander Kutikov, Marc Smaldone, and Andres Correa Kevin GinsburgKevin Ginsburg More articles by this author , David PerlmanDavid Perlman More articles by this author , Alberto Andres Castro BigalliAlberto Andres Castro Bigalli More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Jared SchoberJared Schober More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , and Andres CorreaAndres Correa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001975.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e108-e108 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Ginsburg More articles by this author David Perlman More articles by this author Alberto Andres Castro Bigalli More articles by this author Elizabeth Handorf More articles by this author Jared Schober More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Andres Correa More articles by this author Expand All Advertisement PDF downloadLoading ...