Pd23-08 Rethinking the Definition of Stage Iii in Adrenocortical Carcinoma: Assessing the Impact of Clinical Lymph Node Positive Disease

You have accessJournal of UrologyAdrenal (PD23)1 May 2024PD23-08 RETHINKING THE DEFINITION OF STAGE III IN ADRENOCORTICAL CARCINOMA: ASSESSING THE IMPACT OF CLINICAL LYMPH NODE POSITIVE DISEASE Benjamin J. Lichtbroun, Helen Gao, Kevin Chua, John L. Pfail, Hiren V. Patel, Sammy Elsamra, David Golombos, Vignesh T. Packiam, Eric A. Singer, Thomas L. Jang, Saum Ghodoussipour, and Arnav Srivastava Benjamin J. LichtbrounBenjamin J. Lichtbroun , Helen GaoHelen Gao , Kevin ChuaKevin Chua , John L. PfailJohn L. Pfail , Hiren V. PatelHiren V. Patel , Sammy ElsamraSammy Elsamra , David GolombosDavid Golombos , Vignesh T. PackiamVignesh T. Packiam , Eric A. SingerEric A. Singer , Thomas L. JangThomas L. Jang , Saum GhodoussipourSaum Ghodoussipour , and Arnav SrivastavaArnav Srivastava View All Author Informationhttps://doi.org/10.1097/01.JU.0001008664.51020.58.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Joint Committee on Cancer offers two definitions of stage III adrenocortical carcinoma (ACC), encompassing both lymph node negative (LN-) and lymph node positive (LN+) disease. We examined the impact of clinical LN+ disease on survival in order to evaluate the current staging paradigm in ACC. METHODS: We identified patients with clinical stage III and IV ACC from the National Cancer Database and stratified them into three groups: stage III LN-, stage III LN+ and stage IV. Among stage III ACC, we assessed clinical LN involvement and receipt of systemic therapy or surgery. Overall survival (OS) was assessed with the Kaplan-Meier method. Univariate (UVA) and multivariate (MVA) Cox proportional hazards regression models identified factors associated with inferior OS among patients with stage III ACC. RESULTS: We identified 917 patients – 322 (35%) stage III LN-, 67 (7%) stage III LN+ and 528 (57%) stage IV. 3-year OS for patients with stage III LN-, stage III LN+ and stage IV was 48.6%, 29.4% and 15.6%, respectively (Figure 1). On UVA, patients with stage III LN+ ACC had worse OS than those with stage III LN- (HR 1.72, 95% CI 1.26-2.37, p<0.001), although this relationship did not maintain significance in MVA (Table 1). Systemic therapy was given in 56.2%, 43.3% and 36.2% in stage III LN-, stage III LN+, and stage IV groups, respectively. On both UVA and MVA, older patients and patients who did not have surgery had worse OS. On UVA but not MVA, patients who did not receive systemic therapy had worse OS. 3-year OS was worse in those who did not receive treatment compared to those who did in the stage IV group - this was not seen in the stage III LN+ group. CONCLUSIONS: Our study demonstrates that in patients with stage III ACC, patients with LN+ disease have inferior oncologic outcomes relative to those with LN- on unadjusted analyses. Though our results were limited by sample size, it suggests that clinical LN+ portends worse survival. A staging system that incorporates LN status may more accurately reflect survival outcomes for stage III patients. Download PPT Source of Funding: The work from the Cancer Institute of New Jersey is supported by a grant from the National Cancer Institute: P30CA072720Arnav Srivastava is supported by a training grant from the National Cancer Institute: T32CA180984 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e526 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Benjamin J. Lichtbroun More articles by this author Helen Gao More articles by this author Kevin Chua More articles by this author John L. Pfail More articles by this author Hiren V. Patel More articles by this author Sammy Elsamra More articles by this author David Golombos More articles by this author Vignesh T. Packiam More articles by this author Eric A. Singer More articles by this author Thomas L. Jang More articles by this author Saum Ghodoussipour More articles by this author Arnav Srivastava More articles by this author Expand All Advertisement PDF downloadLoading ...