Assessment of survival and role of chemotherapy in patients with adrenocortical carcinoma: Insights from SEER Database (2000–2021).

Abstract

e16610 Background: Adrenocortical carcinoma (ACC) is a rare malignancy with an incidence of 1-2 per million per year. The optimal treatment remains unclear as does the benefit of chemotherapy (chemo) in patients (pts) with resectable ACC. Methods: The SEER database (2000–2021) was used to identify ACC pts > 18 years. Variables of interest included age, race, household income, rural-urban classification, stage, chemo, radiation therapy (RT), and surgery. Statistical analyses were conducted using ANOVA, Kruskal-Wallis, and Kaplan-Meier methods to compare survival outcomes according to variables of interest. Results: Of the 2,598 pts identified, 1,564 (60%) were female. The majority of pts (85%) were white, followed by black (9%). Most pts (87%) resided in metropolitan areas. Pts with localized, regional, or distant metastatic disease comprised 25%, 17% and 36% of the group, respectively. 40% of pts underwent radical or total surgical removal of the primary site disease while 9%, 2%, and 1% underwent partial surgical removal, excision, or debulking surgery, respectively, and 30% did not undergo surgery. 34% of pts received chemo and 8% received RT. The median overall survival (mOS) for the entire cohort was 15 months (m) (95% CI: 14–17 m). No significant differences in OS were observed among pts of different races or household incomes. Distant metastatic disease was significantly associated with worse mortality when compared with regional or localized diseases (mOS: 5 m vs. 20 m vs 60.6 m, respectively, p < 0.001). Surgical intervention of any kind was associated with longer survival when compared to those who did not undergo surgery (18 m vs. 3 m, HR 0.33, p < 0.0001). Among the 971 pts with distant metastatic disease, pts who received chemo had a superior mOS compared to those who did not receive chemo or with unknown chemo status (8 m vs. 2 m, p < 0.0001). This OS advantage remained significant even after excluding pts who underwent surgery (5 m vs. 2 m, p < 0.0001). While chemo was also associated with longer mOS (29 m vs. 27 m, p < 0.0001) in localized disease, this survival advantage was not present in pts with localized disease managed with surgery (27 m vs. 27 m, p = 0.061). Although chemo was associated with numerically longer mOS in pts with regional disease, the difference was not significant. Conclusions: ACC with distant metastatic disease carries a poor prognosis yet demonstrates superior survival in pts who receive chemo. Surgery is associated with better survival outcomes, but there is no additive benefit from chemo in those with localized disease managed with surgical resection.