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Impact of Micro- and Macroscopically Positive Surgical Margins on Survival after Resection of Adrenocortical Carcinoma

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Adrenocortical carcinoma (ACC) is a rare, aggressive cancer; complete surgical resection offers the best chance for long-term survival. The impact of surgical margin status on survival is poorly understood. Our objective was to determine the association of margin status with survival.

Methods

Patients with ACC were identified from the National Cancer Data Base, 1998–2012, and stratified based on surgical margin status (negative vs. microscopically positive [+] vs. macroscopically [+]). Univariate/multivariate regression/survival analyses were utilized to determine factors associated with margin status and overall survival (OS).

Results

A total of 1553 patients underwent surgery at 589 institutions: 86% had negative, 12% microscopically (+), and 2% macroscopically (+) margins. Those with microscopically (+) and macroscopically (+) margins more often received adjuvant chemotherapy (39.4% macroscopically (+) vs. 38.5% microscopically (+) vs. 25.2% negative margins, p < 0.001). For unadjusted analysis, there was a significant difference in OS between the groups (log-rank p < 0.001), with median survival times of 58 months (95% confidence interval [CI] 49–66) for those with negative margins, 22 months (95% CI 18–34) microscopically (+), and 14 months (95% CI 6–27) macroscopically (+) margins. After adjustment, both microscopically (+) (HR 1.76, p < 0.001) and macroscopically (+) (HR 2.10, p = 0.0019) margin status were associated with compromised survival.

Conclusions

Having micro- or macroscopically (+) margin status after ACC resection is associated with dose-dependent compromised survival. These results underscore the importance of achieving negative surgical margins for optimizing long-term patient outcomes.

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Acknowledgment

This research was supported by a NIH TL-1 clinical and translational science award (CTSA), Grant number 1UL1-TR001117-01 (NCATS). J. A. S. is a member of the data monitoring committee of the Medullary Thyroid Cancer Consortium Registry supported by NovoNordisk, GlaxoSmithKline, Astra Zeneca, and Eli Lilly. The other authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Authors and Affiliations

  1. Duke University School of Medicine, Durham, NC, USA

    Kevin L. Anderson Jr. MHS, Michael T. Stang MD, Randall P. Scheri MD, Sanziana A. Roman MD & Julie A. Sosa MD, MA

  2. Department of Surgery, Duke University School of Medicine, Durham, NC, USA

    Mohamed A. Adam MD, Linda Youngwirth MD, Michael T. Stang MD, Randall P. Scheri MD, Sanziana A. Roman MD & Julie A. Sosa MD, MA

  3. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA

    Samantha M. Thomas MS

  4. Duke Cancer Institute, Durham, NC, USA

    Samantha M. Thomas MS, Michael T. Stang MD, Randall P. Scheri MD, Sanziana A. Roman MD & Julie A. Sosa MD, MA

  5. Duke Clinical Research Institute, Durham, NC, USA

    Julie A. Sosa MD, MA

Authors
  1. Kevin L. Anderson Jr. MHS
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  2. Mohamed A. Adam MD
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  3. Samantha M. Thomas MS
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  4. Linda Youngwirth MD
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  5. Michael T. Stang MD
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  6. Randall P. Scheri MD
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  7. Sanziana A. Roman MD
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  8. Julie A. Sosa MD, MA
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Corresponding author

Correspondence to Randall P. Scheri MD.

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Anderson, K.L., Adam, M.A., Thomas, S.M. et al. Impact of Micro- and Macroscopically Positive Surgical Margins on Survival after Resection of Adrenocortical Carcinoma. Ann Surg Oncol 25, 1425–1431 (2018). https://doi.org/10.1245/s10434-018-6398-5

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  • DOI: https://doi.org/10.1245/s10434-018-6398-5

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