Survival impact of treatment utilization and margin status after resection of adrenocortical carcinoma.

Background: This study examines the combined impact of margin status and adjuvant therapy utilization on overall survival (OS) for adrenocortical carcinoma (ACC) patients undergoing surgery with curative intent.

Methods: The 2004-2020 National Cancer Database (NCDB) was queried for ACC patients ≥18yrs undergoing curative surgery (no debulking), subdivided into R0 and R1/R2-groups, and analyzed using inverse-probability-weighted Cox Proportional Hazard-model.

Results: Of 5023 ACC patients, 3193 underwent curative surgery, 2213 (69 ​%) had R0 margins. Compared to the R0, the R1/R2 group had a decreased OS by 15.6 months (HR ​= ​1.89, p ​= ​0.002). While there has been no significant improvement in margin status over the years studied (2008-2017), there has been an overall increase in the proportion of patients receiving adjuvant therapy regardless of margin status, and the adverse impact of a positive margin on survival has decreased [HR 2.20 vs 1.76] CONCLUSIONS: R1/R2 margins are associated with decreased OS. The adverse impact of R1/R2 margins on OS decreased over time while adjuvant therapy utilization increased for all patients.