22 INCIDENTAL SCREENING FOR ADRENOCORTICAL CARCINOMA (ACC): LESSONS FROM OVER 20 YEARS OF DATA FROM THE NATIONAL CANCER DATA BASE (NCDB) (2011)

You have accessJournal of UrologyAdrenal: Surgery/Tumors/Benign and Malignant Disease1 Apr 201122 INCIDENTAL SCREENING FOR ADRENOCORTICAL CARCINOMA (ACC): LESSONS FROM OVER 20 YEARS OF DATA FROM THE NATIONAL CANCER DATA BASE (NCDB) Alexander Kutikov, Katherine Mallin, Daniel Canter, Yu-Ning Wong, and Robert G. Uzzo Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , Katherine MallinKatherine Mallin Chicago, IL More articles by this author , Daniel CanterDaniel Canter Philadelphia, PA More articles by this author , Yu-Ning WongYu-Ning Wong Philadelphia, PA More articles by this author , and Robert G. UzzoRobert G. Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.084AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ACC is an aggressive malignancy with extremely limited treatment options for regional or systemic disease. Complete surgical resection of localized tumors currently offers the only chance for cure. METHODS We used the NCDB, a joint project of the American College of Surgeons and the American Cancer Society, to assemble a cohort diagnosed with ACC from 1985 to 2007. Cases were limited to ages >=18, ICD-O-3 histology code 8370, and primary site codes C740 and C749. Trends in the distribution of grouped tumor sizes were assessed with the Cochran Armitage Chi-square test. Expected survival rates are based on 1990 life expectancy tables from the National Cancer Institute. Relative 5-year survival rates were calculated for cases diagnosed through 2002. RESULTS Median survival for the full cohort (n=4,275) was 24 months. Patients who were still alive at the end of follow-up had a median follow-up of 67.0 months. Localized ACC accounted for 43.9% of cases, regional disease for 21.7%, and distant disease was documented in 34.4%. No stage migration over time was noted. Mean tumor size was 11.5 cm (median=10.5, range=0-98.9). No statistical trends were noted in changes of tumor size over the years in patients who underwent surgery for localized disease (p=0.32). Furthermore, no improvement in 5-year relative survival over the time period was observed (p>0.1). CONCLUSIONS In this cohort of ACC patients (n=4262)–the largest reported to date–fewer than half presented with localized disease (43.9%). No shift toward lower stage nor smaller tumor size was observed over the study period despite advent of routine cross-sectional imaging and resulting “incidental screening”. These data are in contrast to the well-documented stage and size migration for tumors of the kidney–a neighboring retroperitoneal organ. Extremely rapid growth kinetics of ACC could explain these findings. Furthermore, no improvement in survival was noted over the period of the cohort. As such, minimizing over-treatment of patients with adrenal incidentaloma in whom ACC is considered, while appropriately treating those with ACC remains an essential clinical and epidemiological task. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e8 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Kutikov Philadelphia, PA More articles by this author Katherine Mallin Chicago, IL More articles by this author Daniel Canter Philadelphia, PA More articles by this author Yu-Ning Wong Philadelphia, PA More articles by this author Robert G. Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...