Treatment patterns and outcomes for patients with adrenocortical carcinoma associated with hospital case volume in the United States.

Abstract

Adrenocortical carcinoma (ACC) is a rare, aggressive disease with no apparent change in treatment or survival in the United States over the past two decades. Our objective was to determine whether treatment patterns or clinical outcomes vary by hospital case volume. Patients with ACC were identified from the National Cancer Database (1998-2011). High-volume centers (HVCs) were defined by a case load of ≥4 cases of primary adrenal malignancy annually, which corresponded to the 90th percentile. All other facilities were considered low-volume centers (LVCs). A total of 2,765 ACC patients were treated across 1,046 facilities. Compared to patients treated at LVCs, patients treated at HVCs were younger (50 vs. 54years), with larger tumors (11.2 vs. 10.5cm), and underwent higher rates of surgery (78.8 vs. 73.4%), radical resection (17.3 vs. 13.9%), regional lymph node evaluation (23.2 vs. 18.8%), and chemotherapy including mitotane (43.8 vs. 31.0%, all p<0.05).There were no significant differences in median length of stay (5 vs. 5days), 30-day readmission rates (4.0% for HVCs vs. 3.9% for LVCs), or 30-day postoperative mortality rates (1.9% for HVCs vs. 3.7% for LVCs). Median overall survival was 2.0years for HVCs and 1.9years for LVCs, p=0.53. After adjusting for patient and tumor characteristics, overall survival did not differ significantly between patients treated at HVCs versus LVCs [HR=0.89 (95% confidence interval 0.70, 1.12)]. Treatment at HVCs was associated with more aggressive surgical resection and chemotherapy use. Prognosis remained poor despite more aggressive treatment.