Abstract
BackgroundAdrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy. Surgical resection is the standard treatment for localized ACC, but the local recurrence remains high. Adjuvant radiation (ART) has been proposed as a means to reduce recurrence rates in ACC after surgery with conflicting results from nonrandomized studies. We performed a retrospective study and a meta-analysis to determine the impact of ART on survival outcomes.MethodsA retrospective study of the adrenocortical cancer database in Peking Union Medical College was conducted. We selected postoperative ACC patients with or without ART. A meta-analysis is also performed to compare the outcomes between ART and only surgical resection in ACC patients. The obtained data were analyzed using SPSS 23.0 and Stata 15.0 statistical software. Differences between two groups were compared using the log-rank test for retrospective analysis and estimated by calculating the odds ratio (OR) and 95% confidence interval (CI) for meta-analysis.ResultsOf a total of 75 patients available in the database, 12 patients underwent postoperative ART and were matched one to one to patients with only surgical resection. There was no significant difference on overall survival between ART group and control group (log-rank P = 0.149). Locoregional recurrence was diagnosed in 2 of the ART group, and in 4 of the control group (P = 0.64). A total of 238 participants were selected for the meta-analysis, of which 111 and 127 patients underwent ART after surgical resection and only surgical resection, respectively. Overall survival is significantly higher in ART group, with an odds ratio (OR) of 2.41 (95% CI of 1.33, 4.38; P = 0.004). Besides, meta-analysis significantly favored ART for locoregional recurrence-free survival and disease-free survival, with an OR of 4.08 and 2.27, respectively.ConclusionsOur results show that compared to only surgical resection, ART is an effective postoperative treatment for ACC.
Highlights
Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy
In order to improve clinical decision making, we systematically reviewed the literature for studies evaluating the role of Adjuvant radiation (ART) after primary surgery of ACC, and performed a meta-analysis of oncological outcomes including overall survival (OS), locoregional recurrence-free survival (LRFS), and recurrence-free survival (RFS)
We report our clinical experience with ACC by comparing patients who were treated using surgery followed by ART with those using surgery alone
Summary
Surgical resection is the standard treatment for localized ACC, but the local recurrence remains high. Adjuvant radiation (ART) has been proposed as a means to reduce recurrence rates in ACC after surgery with conflicting results from nonrandomized studies. Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy with an incidence rate of 1–2 case per million population [1]. Surgical resection is the standard treatment for localized ACC to achieve a long-term survival [2]. Locoregional failures are common even after complete surgical resection with estimated rates of local recurrence as high as 30% [3], which was with associated poor long-term survivorship [4]. Adjuvant radiation (ART) has been proposed as a means to reduce high recurrence rates in ACC following surgery with curative intent [6]. Physicians must rely on the critical appraisal of nonrandomized studies with variable patient populations, clinical stage, and outcomes
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