Highlights
- •Children with adrenocortical carcinoma (ACC) had better survival compared to adults.
- •Increasing age, metastatic disease at diagnosis, and retroperitoneal lymph node dissection are associated with poor survival.
- •Adjuvant chemotherapy and radiation do not impact survival.
Abstract
Introduction
Adrenocortical carcinoma (ACC) is associated with poor outcomes. We compared surgical
outcomes between children and adult; and identified factors independently associated
with survival.
Methods
Using the National Cancer Database, children and adults with ACC who underwent surgery
between 2004 and 2016 were identified. We compared outcomes and survival between groups.
Cox regression analysis was performed to identify predictors of survival.
Results
Of 2553 patients, 2.8% were children. A higher proportion of children were Hispanic
(19.1%vs.6.6%) and covered by government insurance (45.1%vs.35.8%) than adults. More
pediatric patients received lymphadenectomy and chemotherapy than adults. Pediatric
patients had better survival at 1 -(91.4%; 95%CI: 81.2%–96.0% vs.79.6%; 95%CI: 77.9%–81.1%)
and 5-years (60.6%; 95%CI:47.5%–71.3% vs.44.9%; 95%CI 42.7%- 47.0) (p = 0.0016). Age≥18
(HR: 2.21(1.50–3.27)), metastatic disease at diagnosis (HR: 3.51(3.04–4.04)), and
receipt of lymphadenectomy (HR: 1.30(1.14–1.48)) were independently associated with
worse survival.
Conclusions
Children with ACC had better survival than adults. Factors independently associated
with worse survival included older age, metastatic disease, and receipt of lymph node
surgery.
Keywords
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Article info
Publication history
Published online: May 25, 2022
Accepted:
May 24,
2022
Received in revised form:
April 12,
2022
Received:
February 22,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
