Effects of Increased Cross-Sectional Imaging on the Diagnosis and Prognosis of Adrenocortical Carcinoma: Analysis of the National Cancer Database

PURPOSE: We assessed whether incidental screening due to imaging performed for other purposes has resulted in earlier detection or better outcomes in patients with adrenocortical carcinoma. MATERIALS AND METHODS: We used the National Cancer Database to assemble a cohort diagnosed with adrenocortical carcinoma from 1985 to 2007. Trends in the distribution of grouped tumor sizes were assessed with the Cochran-Armitage chi-square test. Relative 5-year survival rates were calculated for cases diagnosed through 2002. RESULTS: Median survival in the full cohort of 4,275 patients was 24 months. Localized adrenocortical carcinoma accounted for 43.9% of cases. No stage migration was noted with time. No statistical trends were noted in tumor size changes during the years in patients who underwent surgery for localized disease (p=0.32). No improvement was observed in 5-year survival during the period (p>0.1). CONCLUSIONS: In this cohort of patients with adrenocortical carcinoma, which is to our knowledge the largest cohort reported to date, 43.9% presented with localized disease. No shift was noted toward lower stage or smaller tumor size in a 22-year period despite the advent of abdominal imaging and its resulting incidental screening of the adrenal gland. These data contrast with the well documented stage and size migration of tumors of the kidney, a neighboring retroperitoneal organ. Furthermore, no improvement in survival was noted. As such, better risk stratification of patients with adrenal incidentaloma, while improving treatment efficacy for those with proven adrenocortical carcinoma, is an essential clinical and epidemiological task.