Shuqing Ma, Luming Wu, Lei Ye, Mouhammed Amir Habra, Vania Balderrama-Brondani, Weiqing Wang
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引用次数: 0
Abstract
Purpose: Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of recurrence and poor prognosis. Previous studies revealed controversial roles of adjuvant radiation therapy (RT) in patient management. This study aimed to investigate the role of adjuvant RT in postoperative ACC patients.
Methods: Patients with histologically confirmed ACC who underwent surgical resection in the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2020 were enrolled. Propensity score matching (PSM) was used to balance baseline characteristics between patients receiving adjuvant RT and patients who did not receive RT. Overall survival (OS) and recurrence-free survival (RFS) was analyzed using the Kaplan-Meir method. Risk factors associated with survival outcome was analyzed by univariate and multivariate Cox regression analyses. Subgroup analyses were stratified by European Network for the Study of Adrenal Tumors (ENSAT) disease stage or chemotherapy. A joint retrospective analysis of stage III patients was performed based on data obtained from Ruijin Hospital and MD Anderson Cancer Center.
Results: Among the 700 patients enrolled, 137 patients undergoing postoperative RT were matched with 137 patients who did not receive RT. Overall survival for patients with adjuvant RT was better than patients without RT (log-rank P = 0.015). The 3-year and 5-year OS were 55.2 and 47.1% for patients with RT, vs 42.6 and 34.0% for patients without RT. Multivariate analysis showed adjuvant RT was independently associated with lower mortality (hazard ratio [HR] 0.63, P = 0.007). Subgroup analysis stratified by disease stage demonstrated that adjuvant RT showed the most favorable effect in stage III patients (HR 0.53, P = 0.013). Furthermore, joint analysis of two centers showed a tendency of better OS and local control rate for stage III patients with mitotane plus RT than those with mitotane alone.
Conclusion: Our study indicated that adjuvant RT was associated with improved prognosis for ACC patients, especially for patients with ENSAT stage III diseases. Integrating adjuvant RT into standard care of ACC may be considered.
目的：肾上腺皮质癌（ACC）是一种罕见的恶性肿瘤，复发率高，预后差。先前的研究显示辅助放射治疗（RT）在患者管理中的作用存在争议。本研究旨在探讨辅助RT在ACC术后患者中的作用。方法：纳入2004年至2020年间在监测、流行病学和最终结果（SEER）数据库中接受手术切除的组织学证实的ACC患者。倾向评分匹配（PSM）用于平衡接受辅助RT和未接受RT的患者之间的基线特征。使用Kaplan-Meir方法分析总生存期（OS）和无复发生存期（RFS）。通过单因素和多因素Cox回归分析分析与生存结果相关的危险因素。亚组分析按欧洲肾上腺肿瘤研究网络（ENSAT）疾病分期或化疗进行分层。基于瑞金医院和MD安德森癌症中心的数据，对III期患者进行了联合回顾性分析。结果：纳入的700例患者中，137例患者接受术后放疗，137例患者未接受放疗。辅助放疗患者的总生存率优于未接受放疗的患者（log-rank P = 0.015）。接受放疗患者的3年和5年OS分别为55.2和47.1%，而未接受放疗患者的3年和5年OS分别为42.6和34.0%。多因素分析显示，辅助放疗与较低的死亡率独立相关（风险比[HR] 0.63, P = 0.007）。按疾病分期分层的亚组分析显示，辅助放疗在III期患者中效果最佳（HR 0.53, P = 0.013）。此外，两个中心的联合分析显示，与单独使用米托坦相比，米托坦联合RT治疗的III期患者有更好的OS和局部控制率的趋势。结论：我们的研究表明，辅助RT与ACC患者的预后改善有关，特别是对于伴有ENSAT III期疾病的患者。可以考虑将辅助RT纳入ACC的标准治疗。
期刊介绍：
Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology.
Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted.
Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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