Retrospective analysis of value of radiotherapy for adrenocortical carcinoma based on the SEER database
Objective To assess the impact of adjuvant radiotherapy on the survival of patients who underwent sur-gery for adrenocortical carcinoma(ACC),as well as to analyze prognostic factors related to patient outcomes.Methods Data from the SEER database(2004-2017)of patients with ACC who met the criteria were included.Survival curves,overall survival(OS)and tumor-specific survival(CSS)were obtained by Kaplan-Meier curves and log-rank analysis for both postoperative radiotherapy and surgery alone groups,and Cox's equal proportional risk re-gression model was used to analyze the factors affecting The factors affecting prognosis were analyzed using Cox's risk regression model.Patients with one or less risk factors were classified as low-risk group,and patients with two or more risk factors were classified as high-risk group to derive OS and CSS in both groups,and to analyze the effect of adjuvant radiotherapy on patients'OS in both sub-groups.Results A total of 399 ACC patients,with a median age of 57 years(ranging from 1 to 85),were included in the study.Univariate analysis revealed that younger age,lower histological grade,earlier staging,clearance of 19 lymph nodes,fewer than 4 positive lymph nodes,and receiving radiotherapy were all associated with better overall survival(OS)and cancer-specific survival(CSS).(P＜0.05).Multifactorial analysis showed that adjuvant ra-diotherapy significantly improved OS in postoperative patients(HR,0.62;95％CI,0.41-0.92;P=0.018),with poorer OS and CSS in patients aged＞60 years,In patients with ENSAT stage Ⅲ～Ⅳ,high histological grade,and more than 4 positive lymph nodes(P＜0.05),significant associations were observed.Furthermore,among patients in the high-risk group(5-year OS rate:87.1％versus 90.0％;P=0.048),adjuvant radiotherapy showed a significant benefit.However,no survival benefit was found in patients with ACC in the low-risk group.Conclusion Receiving surgery combined with radiotherapy may improve survival and tumor-specific survival over patients with surgical ACC alone,especially in the high-risk group of patients with 2 or more risk factors.
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