Ma Shuqing, Wu Luming, Ye Lei, Habra Mouhammed Amir, Balderrama-Brondani Vania, Wang Weiqing
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Endocrine. 2025 May;88(2):597-606. doi: 10.1007/s12020-025-04163-5. Epub 2025 Jan 25.
Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of recurrence and poor prognosis. Previous studies revealed controversial roles of adjuvant radiation therapy (RT) in patient management. This study aimed to investigate the role of adjuvant RT in postoperative ACC patients.
Patients with histologically confirmed ACC who underwent surgical resection in the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2020 were enrolled. Propensity score matching (PSM) was used to balance baseline characteristics between patients receiving adjuvant RT and patients who did not receive RT. Overall survival (OS) and recurrence-free survival (RFS) was analyzed using the Kaplan-Meir method. Risk factors associated with survival outcome was analyzed by univariate and multivariate Cox regression analyses. Subgroup analyses were stratified by European Network for the Study of Adrenal Tumors (ENSAT) disease stage or chemotherapy. A joint retrospective analysis of stage III patients was performed based on data obtained from Ruijin Hospital and MD Anderson Cancer Center.
Among the 700 patients enrolled, 137 patients undergoing postoperative RT were matched with 137 patients who did not receive RT. Overall survival for patients with adjuvant RT was better than patients without RT (log-rank P = 0.015). The 3-year and 5-year OS were 55.2 and 47.1% for patients with RT, vs 42.6 and 34.0% for patients without RT. Multivariate analysis showed adjuvant RT was independently associated with lower mortality (hazard ratio [HR] 0.63, P = 0.007). Subgroup analysis stratified by disease stage demonstrated that adjuvant RT showed the most favorable effect in stage III patients (HR 0.53, P = 0.013). Furthermore, joint analysis of two centers showed a tendency of better OS and local control rate for stage III patients with mitotane plus RT than those with mitotane alone.
Our study indicated that adjuvant RT was associated with improved prognosis for ACC patients, especially for patients with ENSAT stage III diseases. Integrating adjuvant RT into standard care of ACC may be considered.
肾上腺皮质癌（ACC）是一种罕见的恶性肿瘤，以高复发率和不良预后著称。既往研究揭示了辅助性放射治疗（RT）在患者管理中的作用存在争议。本研究旨在探讨辅助性RT在ACC术后患者中的作用。
纳入2004年至2020年间在监测、流行病学和最终结果（SEER）数据库中接受手术切除且组织学确诊为ACC的患者。采用倾向评分匹配（PSM）来平衡接受辅助性RT的患者与未接受RT的患者之间的基线特征。使用Kaplan-Meir方法分析总生存期（OS）和无复发生存期（RFS）。通过单因素和多因素Cox回归分析来分析与生存结局相关的危险因素。亚组分析按欧洲肾上腺肿瘤研究网络（ENSAT）疾病分期或化疗进行分层。基于从瑞金医院和MD安德森癌症中心获得的数据，对III期患者进行联合回顾性分析。
在纳入的700例患者中，137例接受术后RT的患者与137例未接受RT的患者进行了匹配。接受辅助性RT的患者的总生存期优于未接受RT的患者（对数秩检验P = 0.015）。接受RT的患者的3年和5年OS分别为55.2%和47.1%，而未接受RT的患者分别为42.6%和34.0%。多因素分析显示辅助性RT与较低的死亡率独立相关（风险比[HR] 0.63，P = 0.007）。按疾病分期分层的亚组分析表明，辅助性RT在III期患者中显示出最有利的效果（HR 0.53，P = 0.013）。此外，两个中心的联合分析显示，对于III期患者，米托坦联合RT组的OS和局部控制率有优于单纯米托坦组的趋势。
我们的研究表明，辅助性RT与ACC患者预后改善相关，尤其是对于ENSAT III期疾病患者。可考虑将辅助性RT纳入ACC的标准治疗中。
