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
•aRT is recommended for patients with localized ACC at risk for recurrence.•In the NCDB, aRT is underutilized in indicated patients (18%).•aRT is associated with improved OS in aptients with PSM, large tumors, or high-grade disease•Limitations include registry data and missing data. To test for an a...
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| Veröffentlicht in: | Urologic oncology 2021-11, Vol.39 (11), p.791.e1-791.e7 |
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| creator | 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. |
| description | •aRT is recommended for patients with localized ACC at risk for recurrence.•In the NCDB, aRT is underutilized in indicated patients (18%).•aRT is associated with improved OS in aptients with PSM, large tumors, or high-grade disease•Limitations include registry data and missing data.
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.
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.
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).
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. |
| doi_str_mv | 10.1016/j.urolonc.2021.06.019 |
| format | Article |
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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.
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.
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).
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.</description><identifier>ISSN: 1078-1439</identifier><identifier>EISSN: 1873-2496</identifier><identifier>DOI: 10.1016/j.urolonc.2021.06.019</identifier><identifier>PMID: 34301459</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adrenocortical carcinoma ; Adrenocortical Carcinoma - mortality ; Adrenocortical Carcinoma - radiotherapy ; Databases, Factual ; Female ; Humans ; Male ; Margin positive ; Overall survival ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk Factors ; Survival Analysis ; United States</subject><ispartof>Urologic oncology, 2021-11, Vol.39 (11), p.791.e1-791.e7</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-39c0ce049da3c52c8d29c02a5b091a496446d119c7a6010cf921f54775a625253</citedby><cites>FETCH-LOGICAL-c365t-39c0ce049da3c52c8d29c02a5b091a496446d119c7a6010cf921f54775a625253</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urolonc.2021.06.019$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34301459$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ginsburg, Kevin B.</creatorcontrib><creatorcontrib>Chandra, Akhil A.</creatorcontrib><creatorcontrib>Schober, Jared P.</creatorcontrib><creatorcontrib>Handorf, Elizabeth A.</creatorcontrib><creatorcontrib>Uzzo, Robert G.</creatorcontrib><creatorcontrib>Greenberg, Richard E.</creatorcontrib><creatorcontrib>Chen, David YT</creatorcontrib><creatorcontrib>Viterbo, Rosalia</creatorcontrib><creatorcontrib>Smaldone, Marc C.</creatorcontrib><creatorcontrib>Kutikov, Alexander</creatorcontrib><creatorcontrib>Hallman, Mark A.</creatorcontrib><creatorcontrib>Correa, Andres F.</creatorcontrib><title>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</title><title>Urologic oncology</title><addtitle>Urol Oncol</addtitle><description>•aRT is recommended for patients with localized ACC at risk for recurrence.•In the NCDB, aRT is underutilized in indicated patients (18%).•aRT is associated with improved OS in aptients with PSM, large tumors, or high-grade disease•Limitations include registry data and missing data.
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.
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.
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).
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.</description><subject>Adrenocortical carcinoma</subject><subject>Adrenocortical Carcinoma - mortality</subject><subject>Adrenocortical Carcinoma - radiotherapy</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Margin positive</subject><subject>Overall survival</subject><subject>Radiotherapy</subject><subject>Radiotherapy, Adjuvant</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival Analysis</subject><subject>United States</subject><issn>1078-1439</issn><issn>1873-2496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc-O1DAMxisEYpeFRwDlyKUlSZt2ygWh4d9IK7jAOfI46U5GbTIkadE-KO-Dhw5w5JLY1uefE39F8VzwSnDRvjpWcwxj8FhJLkXF24qL_kFxLTZdXcqmbx9SzLtNKZq6vyqepHTkXDQbIR4XV3VTU6z66-Lnzlif3eAQsguehYERk8B3VBkZHiACZhtdyg4Tg5QCOsjWsB8uH5ibTjEslNERYRxZmuPiFup0np0ISfC0SsFE6wOGmFcyRHQ-TMBytP-AYI7zAj6zCMatT8oHQp_uX7OdT-7uQLwhhulcZp9_K4i2BY82sneQYQ_JPi0eDTAm--xy3xTfPrz_uv1U3n75uNu-vS2xblUu6x45Wt70BmpUEjdGUkWC2vNeAO2waVojRI8dtFxwHHopBtV0nYJWKqnqm-LlyqUtfJ9tynpyCe04grdhTloqpYTgsj9L1SrFGFKKdtCn6CaI91pwfXZUH_XFUX12VPNWk6PU9-IyYt5P1vzt-mMhCd6sAksfXZyNOiGtHa1x0WLWJrj_jPgF6Vu7eQ</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Ginsburg, Kevin B.</creator><creator>Chandra, Akhil A.</creator><creator>Schober, Jared P.</creator><creator>Handorf, Elizabeth A.</creator><creator>Uzzo, Robert G.</creator><creator>Greenberg, Richard E.</creator><creator>Chen, David YT</creator><creator>Viterbo, Rosalia</creator><creator>Smaldone, Marc C.</creator><creator>Kutikov, Alexander</creator><creator>Hallman, Mark A.</creator><creator>Correa, Andres F.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202111</creationdate><title>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</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-39c0ce049da3c52c8d29c02a5b091a496446d119c7a6010cf921f54775a625253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adrenocortical carcinoma</topic><topic>Adrenocortical Carcinoma - mortality</topic><topic>Adrenocortical Carcinoma - radiotherapy</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Margin positive</topic><topic>Overall survival</topic><topic>Radiotherapy</topic><topic>Radiotherapy, Adjuvant</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival Analysis</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ginsburg, Kevin B.</creatorcontrib><creatorcontrib>Chandra, Akhil A.</creatorcontrib><creatorcontrib>Schober, Jared P.</creatorcontrib><creatorcontrib>Handorf, Elizabeth A.</creatorcontrib><creatorcontrib>Uzzo, Robert G.</creatorcontrib><creatorcontrib>Greenberg, Richard E.</creatorcontrib><creatorcontrib>Chen, David YT</creatorcontrib><creatorcontrib>Viterbo, Rosalia</creatorcontrib><creatorcontrib>Smaldone, Marc C.</creatorcontrib><creatorcontrib>Kutikov, Alexander</creatorcontrib><creatorcontrib>Hallman, Mark A.</creatorcontrib><creatorcontrib>Correa, Andres F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ginsburg, Kevin B.</au><au>Chandra, Akhil A.</au><au>Schober, Jared P.</au><au>Handorf, Elizabeth A.</au><au>Uzzo, Robert G.</au><au>Greenberg, Richard E.</au><au>Chen, David YT</au><au>Viterbo, Rosalia</au><au>Smaldone, Marc C.</au><au>Kutikov, Alexander</au><au>Hallman, Mark A.</au><au>Correa, Andres F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Urologic oncology</jtitle><addtitle>Urol Oncol</addtitle><date>2021-11</date><risdate>2021</risdate><volume>39</volume><issue>11</issue><spage>791.e1</spage><epage>791.e7</epage><pages>791.e1-791.e7</pages><issn>1078-1439</issn><eissn>1873-2496</eissn><abstract>•aRT is recommended for patients with localized ACC at risk for recurrence.•In the NCDB, aRT is underutilized in indicated patients (18%).•aRT is associated with improved OS in aptients with PSM, large tumors, or high-grade disease•Limitations include registry data and missing data.
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.
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.
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).
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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34301459</pmid><doi>10.1016/j.urolonc.2021.06.019</doi></addata></record> |
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| ispartof | Urologic oncology, 2021-11, Vol.39 (11), p.791.e1-791.e7 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adrenocortical carcinoma Adrenocortical Carcinoma - mortality Adrenocortical Carcinoma - radiotherapy Databases, Factual Female Humans Male Margin positive Overall survival Radiotherapy Radiotherapy, Adjuvant Retrospective Studies Risk Factors Survival Analysis United States |
| title | 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 |
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