Positive Lymph Nodes in Adrenocortical Carcinoma: What Does It Mean?
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ORIGINAL SCIENTIFIC REPORT
Positive Lymph Nodes in Adrenocortical Carcinoma: What Does It Mean? Alaa Sada1 • Amy E. Glasgow2 • Melanie L. Lyden1 • Geoffrey B. Thompson1 • Benzon M. Dy1 Travis J. McKenzie1 • Elizabeth B. Habermann1,2
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Accepted: 15 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The role of lymphadenectomy in adrenocortical carcinoma resection is controversial. Therefore, we conducted a population-based study to assess the association between positive lymph nodes (LN) and survival. Methods The Surveillance, Epidemiology, and End Results set of cancer registries were utilized. The associations between positive lymph nodes and tumor size, grade and laterality were assessed. Cancer specific survival (CSS) trends and factors affecting survival were analyzed. Results A total of 2170 adult patients were identified; 60% underwent resection. Among those resected, LN were examined in 23% and were positive in 25% of patients with LN examined. Patients with positive LN tended to have smaller tumors compared to those with negative LN (12 ± 5 vs 15 ± 11 cm, p = 0.02). The rate of positive LN was higher in right ACC, p = 0.03. Median overall CSS was 21 months, with significant differences between resection (42 months) and no resection (4 months), p \ 0.01. Median CSS did not change over time when comparing ACC patients who underwent surgery before 2000, 2000–2009, and 2010–2016. On multivariable analysis including resection group, advanced age, grades III and IV, regional and distant stage, in addition to positive LN were associated with worse survival, p \ 0.05. Conclusion Lymphadenectomy is infrequently performed during ACC resection, and when performed, regional LN involvement tends to be associated with worse survival. Neoplasm size and grade were not associated with LN involvement and therefore, do not inform lymphadenectomy need. Further studies are needed to assess the indications for, and value of lymphadenectomy in ACC.
Introduction Adrenocortical carcinoma (ACC) is a rare malignancy that develops in the adrenal cortex and progresses rapidly to advanced stages [1, 2]. Unfortunately, due to aggressive tumor biology, hormonal over-secretion and advanced & Elizabeth B. Habermann [email protected] 1
Department of Surgery, Mayo Clinic, Rochester, MN, USA
2
Surgical Outcomes Program, Robert D and Patricia E Kern Center for The Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
stages at presentation, these neoplasms are associated with very poor survival—a median overall survival of only 35 months [1]. A recent SEER based study suggested that ACC prognosis not only continues to be poor, but it has been getting worse overtime [3]. Complete surgical resection is the only curative option for ACC as the role of neoadjuvant and adjuvant therapy is very limited [4]. As a result, aggressive surgical resection, even for advanced or metastatic disease, has been advocated in carefully selected patients [5, 6]. Moreover, other studies have advocated for re
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