Wu Kan, Liu Xu, Liu Zhihong, Lu Yiping, Wang Xianding, Li Xiang
Department of Urology, Institute of Urology, and.
Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China.
J Natl Compr Canc Netw. 2021 Dec;19(12):1425-1432. doi: 10.6004/jnccn.2021.7035.
Adrenocortical carcinoma (ACC) is an aggressive cancer with high recurrence rates and poor prognosis, even after radical surgery. The survival benefit of adjuvant radiotherapy (RT) in patients with ACC has not been well explored. The aim of this study was to evaluate the effect of adjuvant RT on the survival outcome of patients with ACC.
All patients with nonmetastatic ACC who underwent complete resection were identified from the SEER database (2004-2016). Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox regression analysis was performed to identify prognostic factors associated with survival.
Of 365 patients with nonmetastatic ACC, 55 (15.1%) received adjuvant RT and the remainder underwent surgery alone. Patient characteristics were similar between the 2 groups, but those with a higher disease stage were more likely to receive adjuvant RT. Overall, patients receiving RT seemed to have better survival compared with the non-RT group (3-year OS rate, 63.1% vs 52.8%; P<.062). After adjustment for confounding factors, adjuvant RT was indeed associated with a 48% decreased risk of death (hazard ratio, 0.52; 95% CI, 0.29-0.91; P=.023) for all patients. In addition, adjuvant RT may confer a survival benefit only in patients with a high risk of recurrence (3-year OS rate, 55.1% vs 40.0%; P=.048) rather than in those with low/moderate-risk ACC (P=.559).
Our findings suggest that adjuvant RT may be associated with improved survival in patients with nonmetastatic ACC who underwent radical surgery, especially those with high risk of recurrence.
肾上腺皮质癌（ACC）是一种侵袭性癌症，即使在根治性手术后，复发率也很高，预后较差。辅助放疗（RT）对ACC患者生存获益的影响尚未得到充分研究。本研究的目的是评估辅助放疗对ACC患者生存结局的影响。
从监测、流行病学和最终结果（SEER）数据库（2004 - 2016年）中识别出所有接受了完整切除的非转移性ACC患者。采用Kaplan-Meier方法估计总生存期（OS）。进行多变量Cox回归分析以确定与生存相关的预后因素。
在365例非转移性ACC患者中，55例（15.1%）接受了辅助放疗，其余患者仅接受了手术。两组患者的特征相似，但疾病分期较高的患者更有可能接受辅助放疗。总体而言，与未接受放疗的组相比，接受放疗的患者似乎生存情况更好（3年总生存率，63.1%对52.8%；P<0.062）。在对混杂因素进行调整后，辅助放疗确实与所有患者死亡风险降低48%相关（风险比，0.52；95%置信区间，0.29 - 0.91；P = 0.023）。此外，辅助放疗可能仅对复发风险高的患者有生存获益（3年总生存率，55.1%对40.0%；P = 0.048），而对低/中度风险的ACC患者无此获益（P = 0.559）。
我们的研究结果表明，辅助放疗可能与接受根治性手术的非转移性ACC患者生存率提高相关，尤其是那些复发风险高的患者。
