Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, Illinois.
Division of Transplant, Department of Surgery, Rush University Medical Center, Chicago, Illinois.
J Clin Endocrinol Metab. 2019 Dec 1;104(12):5948-5956. doi: 10.1210/jc.2019-00915.
Adrenocortical carcinoma (ACC) is a rare malignancy with a dismal prognosis. Two landmark trials published in 2007 and 2012 showed efficacy for adjuvant mitotane in resectable ACC and etoposide/doxorubicin/cisplatin plus mitotane for unresectable ACC, respectively. In this study, we used the National Cancer Database to examine whether treatment patterns and outcomes changed after these trials.
The National Cancer Database was used to examine treatment patterns and survival in patients diagnosed with ACC from 2006 to 2015. Treatment modalities were compared within that group and with a historical cohort (1985 to 2005). χ2 tests were performed, and Cox proportional hazards models were created.
From 2006 to 2015, 2752 patients were included; 38% of patients (1042) underwent surgery alone, and 31% (859) underwent surgery with adjuvant therapy. Overall 5-year survival rates for all stages after resection were 43% (median, 41 months) in the contemporary cohort and 39% (median, 32 months) in the historical cohort. After 2007, patients who underwent surgery were more likely to receive adjuvant chemotherapy (P = 0.005), and 5-year survival with adjuvant chemotherapy improved (41% vs 25%; P = 0.02). However, survival did not improve in patients with unresectable tumors after 2011 compared with 2006 to 2011 (P = 0.79). Older age, tumor size ≥10 cm, distant metastases, and positive margins were associated with lower survival after resection (hazard ratio range: 1.39 to 3.09; P < 0.03).
Since 2007, adjuvant therapy has been used more frequently in patients with resected ACC, and survival for these patients has improved but remains low. More effective systemic therapies for patients with ACC, especially those in advanced stages, are desperately needed.
肾上腺皮质癌（ACC）是一种罕见的恶性肿瘤，预后极差。2007 年和 2012 年发表的两项里程碑式试验分别显示出辅助 mitotane 对可切除 ACC 以及依托泊苷/多柔比星/顺铂联合 mitotane 对不可切除 ACC 的疗效。在这项研究中，我们使用国家癌症数据库来研究这两项试验后治疗模式和结局是否发生变化。
使用国家癌症数据库检查 2006 年至 2015 年间诊断为 ACC 的患者的治疗模式和生存情况。在该组内并与历史队列（1985 年至 2005 年）比较治疗方式。进行 χ2 检验，并创建 Cox 比例风险模型。
2006 年至 2015 年期间，共纳入 2752 例患者；38%（1042 例）患者仅接受手术治疗，31%（859 例）患者接受手术联合辅助治疗。所有分期切除后的 5 年总生存率在当代队列中为 43%（中位数，41 个月），在历史队列中为 39%（中位数，32 个月）。2007 年后，接受手术的患者更有可能接受辅助化疗（P=0.005），且接受辅助化疗的 5 年生存率提高（41%比 25%；P=0.02）。然而，与 2006 年至 2011 年相比，2011 年后不可切除肿瘤患者的生存情况并未改善（P=0.79）。切除后，年龄较大、肿瘤直径≥10cm、远处转移和切缘阳性与生存率降低相关（风险比范围：1.39 至 3.09；P<0.03）。
自 2007 年以来，辅助治疗在接受切除的 ACC 患者中更为常用，且这些患者的生存率有所提高，但仍较低。迫切需要针对 ACC 患者，特别是晚期患者的更有效的全身治疗方法。
