Adrenalectomy extends survival in metastatic adrenocortical carcinoma

Undergoing adrenalectomy may help reduce mortality in patients with metastatic adrenocortical carcinoma (mACC), particularly in those with exposure to systemic therapy and those with lung-only metastases, according to a study.

A total of 543 patients with mACC were included, of whom 194 (36 percent) underwent adrenalectomy. Multivariable analyses revealed the association of adrenalectomy with lower overall mortality (hazard ratio [HR], 0.39; p<0.001), as did the 3 months’ landmark analyses (HR, 0.57; p=0.002).

The protective benefit of adrenalectomy in the 3 months’ landmark analyses was noted in patients exposed to systemic therapy (HR, 0.49; p<0.001), contemporary patients (HR, 0.57; p=0.004), historical patients (HR, 0.42; p<0.001), and in those with lung-only solitary metastasis (HR, 0.50; p=0.02).

On the other hand, no significant association was found in patients naive to systemic therapy (HR, 0.68; p=0.3), those with multiple metastatic sites (HR, 0.55; p=0.07), and those with liver-only solitary metastasis (HR, 0.98; p=0.9).

In this study, the researchers identified patients aged ≥18 years with mACC at initial presentation who were treated between 2004 and 2020 within the Surveillance, Epidemiology, and End Results database. They then tested for differences according to adrenalectomy status. Kaplan-Meier plots, multivariable Cox regression models, and landmark analyses were used.

The researchers also performed sensitivity analyses with focus on the use of systemic therapy, contemporary (2012–2020) vs historical (2004–2011), single vs multiple metastatic sites, and assessable specific solitary metastatic sites (lung only and liver only).