Laparoscopic Surgery for Adrenocortical Carcinoma: Estimating the Risk of Margin-Positive Resection

Author(s)

Carlisle K1, Blackburn K1, Okoye G2, Japp E3, McArdle P4, Turner D1, Englum B1, Smith P5, Hu Y1
1University of Maryland School of Medicine, Department of Surgery, Baltimore, MD, USA, 2University of Maryland School of Pharmacy, Baltimore, MD, USA, 3University of Maryland School of Medicine, Department of Medicine, Baltimore, MD, USA, 4University of Maryland School of Medicine, Department of Epidemiology & Public Health, Baltimore, MD, USA, 5Univerisity of Virginia School of Medicine, Charlottesville, VA, USA

Presentation Documents

OBJECTIVES: Recent consensus guidelines herald an expanding role for minimally-invasive surgery (MIS) in the treatment of adrenocortical carcinoma (ACC). However, MIS has been associated with non-curative resection and locoregional recurrence. We aimed to identify risk factors for margin-positivity among patients who undergo MIS resection for ACC. We hypothesized that a simple nomogram can accurately identify patients most suitable for oncologically-sound MIS resection.

METHODS: Curative-intent resections for ACC were identified through the National Cancer Database spanning 2010-2018. Trends in MIS utilization were reported using Pearson correlation coefficient. Factors associated with margin-positive resection were identified among preoperatively-available variables using multivariable logistic regression, then incorporated into a predictive model. Model quality was cross-validated using an 80% training dataset and 20% test dataset.

RESULTS: Among 1260 ACC cases, 38.6% (486) underwent MIS resection. MIS utilization increased over time at non-academic centers (R=0.79, p=0.011), but not at academic centers (R=0.08, p=0.834). Factors associated with margin-positive MIS resection were increasing age, non-academic center (OR 2.0, p=0.008), cT3 (OR 5.2, p<0.001) and cT4 tumors (OR 28.0, p<0.001), and right-sided tumors (OR 2.1, p=0.005). A predictive model incorporating these four factors produced favorable c-statistics of 0.75 in the training dataset and 0.72 in the test dataset. The corresponding predictive nomogram is presented in Figure 1.

CONCLUSIONS: An increasing proportion of adrenocortical carcinomas are resected via minimally-invasive operations, particularly at non-academic centers. Patient selection based on a few key factors can minimize the risk of non-curative surgery.

Figure 1: Nomogram estimating the risk of margin-positivity for laparoscopic- and robotic-resected adrenocortical carcinoma. For example, a 65-year-old patient (33 pts) with a cT3 (57 pts), right-sided tumor (25 pts) at an academic center (0 pts) would have a 50% risk of margin-positive resection.

Conference/Value in Health Info

2023-05, ISPOR 2023, Boston, MA, USA

Value in Health, Volume 26, Issue 6, S2 (June 2023)

Code

RWD16

Topic

Real World Data & Information Systems, Study Approaches

Topic Subcategory

Health & Insurance Records Systems

Disease

Diabetes/Endocrine/Metabolic Disorders (including obesity), Surgery

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