Skip to main content
SpringerLink
Log in

Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Adrenocortical carcinoma (ACC) is a rare, aggressive disease with no apparent change in treatment or survival in the United States over the past two decades. Our objective was to determine whether treatment patterns or clinical outcomes vary by hospital case volume.

Methods

Patients with ACC were identified from the National Cancer Database (1998–2011). High-volume centers (HVCs) were defined by a case load of ≥4 cases of primary adrenal malignancy annually, which corresponded to the 90th percentile. All other facilities were considered low-volume centers (LVCs).

Results

A total of 2,765 ACC patients were treated across 1,046 facilities. Compared to patients treated at LVCs, patients treated at HVCs were younger (50 vs. 54 years), with larger tumors (11.2 vs. 10.5 cm), and underwent higher rates of surgery (78.8 vs. 73.4 %), radical resection (17.3 vs. 13.9 %), regional lymph node evaluation (23.2 vs. 18.8 %), and chemotherapy including mitotane (43.8 vs. 31.0 %, all p < 0.05).There were no significant differences in median length of stay (5 vs. 5 days), 30-day readmission rates (4.0 % for HVCs vs. 3.9 % for LVCs), or 30-day postoperative mortality rates (1.9 % for HVCs vs. 3.7 % for LVCs). Median overall survival was 2.0 years for HVCs and 1.9 years for LVCs, p = 0.53. After adjusting for patient and tumor characteristics, overall survival did not differ significantly between patients treated at HVCs versus LVCs [HR = 0.89 (95 % confidence interval 0.70, 1.12)].

Conclusions

Treatment at HVCs was associated with more aggressive surgical resection and chemotherapy use. Prognosis remained poor despite more aggressive treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fassnacht M, Johanssen S, Quinkler M, et al. Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma: proposal for a Revised TNM Classification. Cancer. 2009;115:243–50.

    Article  PubMed  Google Scholar 

  2. Pommier RF, Brennan MF. An eleven-year experience with adrenocortical carcinoma. Surgery. 1992;112:963–70.

    CAS  PubMed  Google Scholar 

  3. Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol. 1999;6:719–26.

    Article  CAS  PubMed  Google Scholar 

  4. Bellantone R, Ferrante A, Boscherini M, et al. Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma. Surgery. 1997;122:1212–8.

    Article  CAS  PubMed  Google Scholar 

  5. Icard P, Goudet P, Charpenay C, et al. Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg. 2001;25:891–7.

    Article  CAS  PubMed  Google Scholar 

  6. Stojadinovic A, Ghossein RA, Hoos A, et al. Adrenocortical carcinoma: clinical, morphologic, and molecular characterization. J Clin Oncol. 2002;20:941–50.

    Article  CAS  PubMed  Google Scholar 

  7. Terzolo M, Angeli A, Fassnacht M, et al. Adjuvant mitotane treatment for adrenocortical carcinoma. N Engl J Med. 2007;356:2372–80.

    Article  CAS  PubMed  Google Scholar 

  8. Fassnacht M, Terzolo M, Allolio B, et al. Combination chemotherapy in advanced adrenocortical carcinoma. N Engl J Med. 2012;366:2189–97.

    Article  CAS  PubMed  Google Scholar 

  9. Berruti A, Fassnacht M, Baudin E, et al. Adjuvant therapy in patients with adrenocortical carcinoma: a position of an international panel. J Clin Oncol. 2010;28:e401–2.

    Article  PubMed  Google Scholar 

  10. Neuroendocrine tumors. NCCN clinical practice guidelines in oncology, Version 1; 2012. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.

  11. Bilimoria KY, Shen WT, Elaraj D, et al. Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer. 2008;113:3130–6.

    Article  PubMed  Google Scholar 

  12. Kendrick ML, Lloyd R, Erickson L, et al. Adrenocortical carcinoma: surgical progress or status quo? Arch Surg. 2001;136:543–9.

    Article  CAS  PubMed  Google Scholar 

  13. Grubbs EG, Callender GG, Xing Y, et al. Recurrence of adrenal cortical carcinoma following resection: surgery alone can achieve results equal to surgery plus mitotane. Ann Surg Oncol. 2010;17:263–70.

    Article  PubMed  Google Scholar 

  14. Vassiolopoulou-Sellin R, Schultz PN. Adrenocortical carcinoma: clinical outcome at the end of the 20th century. Cancer. 2001;92:1113–21.

    Article  Google Scholar 

  15. Winchester DP, Stewart AK, Bura C, Jones RS. The National Cancer Data Base: a clinical surveillance and quality improvement tool. J Surg Oncol. 2004;85:1–3.

    Article  PubMed  Google Scholar 

  16. Raghunathan TW, Lepkowksi JM, Van Hoewyk J, Solenbeger P. A multivariate technique for multiply imputing missing values using a sequence of regression models. Surv Method. 2001;27:85–95.

    Google Scholar 

  17. White IR, Royston P. Imputing missing covariate values for the Cox model. Stat Med. 2009;28:1982–98.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Park HS, Roman SA, Sosa JA. Outcomes from 3144 adrenalectomies in the United States. Which matters more, surgeon volume or specialty? Arch Surg. 2009;144:1060–7.

    Article  PubMed  Google Scholar 

  19. Villar JM, Moreno P, Ortega J, et al. Results of adrenal surgery. Data of a Spanish national survey. Langenbecks Arch Surg. 2010;395:837–43.

    Article  PubMed  Google Scholar 

  20. Kerkhofs TM, Verhoeven RH, Bonjer HJ, et al. Surgery for adrenocortical carcinoma in the Netherlands: analysis of the national cancer registry data. Eur J Endocrinol. 2013;169:83–9.

    Article  CAS  PubMed  Google Scholar 

  21. Lombardi CP, Raffaelli M, Boniardi M, et al. Adrenocortical carcinoma: effect of hospital volume on patient outcome. Langenbecks Arch Surg. 2012;397:201.

    Article  PubMed  Google Scholar 

  22. Fassnacht M, Johanssen S, Fenske W, et al. Improved survival in patients with stage II adrenocortical carcinoma followed up prospectively by specialized centers. J Clin Endocrinol Metab. 2010;95:4925–32.

    Article  CAS  PubMed  Google Scholar 

  23. Else T, Williams AR, Sabolch A, Jolly S, Miller BS, Hammer GD. Adjuvant therapies and patient and tumor characteristics associated with survival of adult patients with adrenocortical carcinoma. J Clin Endocrinol Metab. 2014;99:455–61.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The data used in the study were derived from a deidentified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA

    Lauren Gratian MD

  2. Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA

    John Pura MPH

  3. Duke Clinical Research Institute, Durham, NC, USA

    Michaela Dinan PhD, Shelby Reed PhD & Julie Ann Sosa MD

  4. Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA

    Randall Scheri MD, Sanziana Roman MD & Julie Ann Sosa MD

Authors
  1. Lauren Gratian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John Pura MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michaela Dinan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shelby Reed PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Randall Scheri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sanziana Roman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Julie Ann Sosa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sanziana Roman MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gratian, L., Pura, J., Dinan, M. et al. Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States. Ann Surg Oncol 21, 3509–3514 (2014). https://doi.org/10.1245/s10434-014-3931-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3931-z

Keywords

Search

Navigation