Open Access

ARTICLE

Association of tumor size with metastatic potential and survival in patients with adrenocortical carcinoma: an analysis of the National Cancer Database

Daniel J. Canter¹, Katherine Mallin², Robert G. Uzzo³, Brian L. Egleston³, Jay Simhan³, John Walton³, Marc C. Smaldone³, Viraj A. Master¹, Gennady Bratslavsky⁴, Alexander Kutikov³

1 Emory University, Atlanta, Georgia, USA
2 National Cancer Data Base, American College of Surgeons, Chicago, Illinois, USA
3 Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
4 SUNY Upstate Medical University, Syracuse, New York, New York, USA
Address correspondence to Dr. Alexander Kutikov, Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA

Canadian Journal of Urology 2013, 20(5), 6915-6921.

Abstract

Introduction: To assess the impact of size at presentation in patients with adrenocortical carcinoma (ACC) on rates of synchronous metastatic disease and survival following resection using a large administrative dataset.
Materials and methods: We queried the National Cancer Database (NCDB) dataset to assemble a cohort of patients with ACC based on SEER staging (1985-2000). Patients were stratified into three groups based on surgical tumor size cutoffs: < 4 cm, 4 cm-6 cm, and > 6 cm. Rates of metastatic disease at presentation in all ACC patients as well as relative survival for patients after resection of localized lesions were calculated and compared among groups.
Results: A total of 2248 patients had available staging information for analysis. Tumor size at presentation did not relate to likelihood of non-localized disease at presentation (p = 0.09). A restricted cubic splines analysis revealed a clinically insignificant relationship between tumor size and advanced disease at presentation (OR = 1.02 for each centimeter change in tumor size, p = 0.004, 95% CI 1.01-1.03). On multivariate analysis, only patient age (p < 0.01), and not tumor size, was a significant predictor of overall survival among patients undergoing resection of localized ACCs.
Conclusions: Our data suggest that tumor size is imperfect in predicting presence of distant disease at presentation, nor does it consistently correlate with patient survival after resection of localized ACC.

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