Publication:
Prognostic significance of lymph node count in surgically treated patients with T2-4 stage nonmetastatic adrenocortical carcinoma

dc.contributor.coauthorAssad, Anis
dc.contributor.coauthorBarletta, Francesco
dc.contributor.coauthorIncesu, Reha-Baris
dc.contributor.coauthorScheipner, Lukas
dc.contributor.coauthorMorra, Simone
dc.contributor.coauthorBaudo, Andrea
dc.contributor.coauthorGarcia, Cristina Cano
dc.contributor.coauthorTian, Zhe
dc.contributor.coauthorAhyai, Sascha
dc.contributor.coauthorLongo, Nicola
dc.contributor.coauthorChun, Felix K.H.
dc.contributor.coauthorShariat, Shahrokh F.
dc.contributor.coauthorBriganti, Alberto
dc.contributor.coauthorSaad, Fred
dc.contributor.coauthorKarakiewicz, Pierre I.
dc.contributor.kuauthorTilki, Derya
dc.date.accessioned2024-12-29T09:40:09Z
dc.date.issued2024
dc.description.abstractPurpose: The role of lymphadenectomy and the optimal lymph node count (LNC) cut-off in nonmetastatic adrenocortical carcinoma (nmACC) are unclear. Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database, surgically treated nmACC patients with T2-4 stages were identified between 2004 and 2020. We tested for cancer-specific mortality (CSM) differences according to pathological N-stage (pN0 vs. pN1) and two previously recommended LNC cut-offs (≥4 vs. ≥5) were tested in pN0 and subsequently in pN1 subgroups in Kaplan-Meier plots and multivariable Cox regression models. Results: Of 710 surgically treated nmACC patients, 185 (26%) underwent lymphadenectomy and were assessable for further analyses based on available LNC data. Of 185 assessable patients, 152 (82%) were pN0 and 33 (18%) were pN1. In Kaplan-Meier analyses, CSM-free survival was 74 vs. 14 months (Δ 60 months, P ≤ 0.001) in pN0 vs. pN1 patients, respectively. In multivariable analyses, pN1 was an independent predictor of higher CSM (HR:3.13, P < 0.001). In sensitivity analyses addressing pN0, LNC cut-off of ≥4 was associated with lower CSM (multivariable hazard ratio [HR]: 0.52; P = 0.002). In sensitivity analyses addressing pN0, no difference was recorded when a LNC cut-off of ≥5 was used (HR:0.60, P = 0.09). In pN1 patients, neither of the cut-offs (≥4 and ≥5) resulted in a statistically significant stratification of CSM rate, and neither reached independent predictor status (all P > 0.05). Conclusions: Lymphadenectomy provides a prognostic benefit in nmACC patients and identifies pN1 patients with dismal prognosis. Conversely, in pN0 patients, a LNC cut-off ≥4 identifies those with particularly favorable prognosis. © 2024 Elsevier Inc.
dc.description.indexedbyWoS
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.issue8
dc.description.publisherscopeInternational
dc.description.volume42
dc.identifier.doi10.1016/j.urolonc.2024.04.003
dc.identifier.eissn1873-2496
dc.identifier.issn1078-1439
dc.identifier.quartileQ2
dc.identifier.scopus2-s2.0-85190965223
dc.identifier.urihttps://doi.org/10.1016/j.urolonc.2024.04.003
dc.identifier.urihttps://hdl.handle.net/20.500.14288/23226
dc.identifier.wos1352858400004
dc.keywordsAdrenalectomy
dc.keywordsAdrenocortical carcinoma
dc.keywordsLymph node dissection
dc.keywordsLymphadenectomy
dc.keywordsLymph node examination
dc.languageen
dc.publisherElsevier Inc.
dc.sourceUrologic Oncology: Seminars and Original Investigations
dc.subjectOncology
dc.subjectUrology and nephrology
dc.titlePrognostic significance of lymph node count in surgically treated patients with T2-4 stage nonmetastatic adrenocortical carcinoma
dc.typeJournal article
dspace.entity.typePublication
local.contributor.kuauthorTilki, Derya
local.publication.orgunit1SCHOOL OF MEDICINE
local.publication.orgunit2School of Medicine

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