Survival impact of treatment utilization and margin status after resection of adrenocortical carcinoma

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2024-10-05 DOI:10.1016/j.amjsurg.2024.115999

Kelvin Memeh , Sara Abou Azar , Oluwasegun Afolaranmi , Tanaz M. Vaghaiwalla

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Abstract

Background

This study examines the combined impact of margin status and adjuvant therapy utilization on overall survival (OS) for adrenocortical carcinoma (ACC) patients undergoing surgery with curative intent.

Methods

The 2004–2020 National Cancer Database (NCDB) was queried for ACC patients ≥18yrs undergoing curative surgery (no debulking), subdivided into R0 and R1/R2-groups, and analyzed using inverse-probability-weighted Cox Proportional Hazard-model.

Results

Of 5023 ACC patients, 3193 underwent curative surgery, 2213 (69 %) had R0 margins. Compared to the R0, the R1/R2 group had a decreased OS by 15.6 months (HR = 1.89, p = 0.002). While there has been no significant improvement in margin status over the years studied (2008–2017), there has been an overall increase in the proportion of patients receiving adjuvant therapy regardless of margin status, and the adverse impact of a positive margin on survival has decreased [HR 2.20 vs 1.76]

Conclusions

R1/R2 margins are associated with decreased OS. The adverse impact of R1/R2 margins on OS decreased over time while adjuvant therapy utilization increased for all patients.

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肾上腺皮质癌切除术后治疗利用率和边缘状态对存活率的影响。

背景：本研究探讨了肾上腺皮质癌（ACC）患者接受根治性手术后，边缘状态和辅助治疗对其总生存期（OS）的综合影响：本研究探讨了肾上腺皮质癌（ACC）患者接受根治性手术后，边缘状态和辅助治疗对总生存期（OS）的综合影响：对2004-2020年全国癌症数据库（NCDB）中接受根治性手术（无清创）的年龄≥18岁的肾上腺皮质癌（ACC）患者进行查询，将其细分为R0组和R1/R2组，并采用逆概率加权的Cox比例危险模型进行分析：在5023名ACC患者中，3193人接受了根治性手术，2213人（69%）的边缘为R0。与 R0 相比，R1/R2 组的 OS 减少了 15.6 个月（HR = 1.89，P = 0.002）。虽然在研究期间（2008-2017 年），边缘状态没有明显改善，但无论边缘状态如何，接受辅助治疗的患者比例总体上有所增加，边缘阳性对生存的不利影响也有所下降[HR 2.20 vs 1.76] 结论：R1/R2边缘与OS下降有关。随着时间的推移，R1/R2边缘对OS的不利影响逐渐减小，而所有患者的辅助治疗使用率均有所上升。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.