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Endocrine

E176: Impact of surgical margin status on survival after curative resection of adrenocortical carcinoma

Introduction: The impact of surgical margin status on survival of patients with adrenocortical carcinoma (ACC), that are eligible for curative surgery is poorly understood. In this study, we attempted to address this question utilizing the National Cancer Data Base.

Methods: The 2004 – 2020 National Cancer Database was queried for all patients > 18 years with a diagnosis of ACC. Patients' demographic, socio-economic, tumor-related, chemotherapy, and surgery-related data were extracted. Only patients who underwent surgical resection were included in this study. We excluded patients with metastases at the time of diagnosis as well as those who had debunking surgery. Patients were divided into two groups (based on the status of their surgical resection margin): R0 (i.e., negative surgical margin) and R1/R2 group (i.e., microscopic or gross positive surgical margin). We then deployed an inverse-probability-weighted Cox Proportional Hazard model to estimate the association between surgical margin status and overall survival.

Results:

 Of the 5,023 patients who had a diagnosis of ACC, 3,193 had surgical resection with curative intent; out which 2,213 (69%) had a R0 margin status. The median, 5-year and 10-year overall survival were 78.8 months, 55.7% and 41.1% in patient with R0 resection, versus 22.9 months, 30.4% and 21.1 % in R1/R2 resection, respectively [Stratified Log-Rank test: p = 0.006]. The inverse-probability-weighted Cox proportional hazard model estimate suggests that compared to an R0 margin status, R1/R2 margin status is associated with an increase mortality [ HR 1.89, 95%CI 1.50 -2.39, p = 0.002], and a decrease in overall survival by 14.7 months [ 95%CI 5.6 - 24 months, p = 0.002].


In patients with postoperative diagnosis of early-stage disease (stages I &II), R1/R2 margin status was associated with a decrease in OS by 27 months (10.7 – 43.4 months, p = 0.001). In advanced-stage disease (Stages III & IV), R1/R2 margin status was associated with a decrease in OS by 4.9 months (5.6 – 15.3 months, p =0.362).

Conclusions:

This study suggests that a positive surgical margin following curative resection of adrenocortical carcinoma is associated with a decreased overall survival, even in early-stage disease, highlighting the importance for surgeons to   achieve a complete resection. 

Learning Objectives:

  • understand the impact of margin status on survival for patients undergoing adrenocortical carcinoma with curative intent.
  • compared to R0 resection, an R1/R2 resection margin status is associated with statistically significant increase in mortality [HR 1.86, 95%CI 1.59 -2.17, p < 0.001].
  • compared to R0 resection, an R1/R2 resection margin status is associated with decreased survival by 19.4 months.