Adrenocortical carcinoma: effect of hospital volume on patient outcome

PURPOSE: Optimal management of adrenocortical carcinoma (ACC) involves a detailed\r\ndiagnostic workup, radical surgery, and appropriate adjuvant therapy. However,\r\ndue to the rarity of this disease, adequate expertise is necessary to ensure\r\noptimal patient care. We evaluated if the experience of a treating center\r\ninfluences the outcome of ACC.\r\nMETHODS: Two hundred sixty-three patients who underwent adrenalectomy for ACC\r\nwere included in a multi-institutional surgical survey and divided into 2 groups:\r\n"high-volume center" (HVC) (≥10 adrenalectomies for ACC) and "low-volume center" \r\n(LVC) (<10 adrenalectomies for ACC). A comparative analysis was performed.\r\nRESULTS: One hundred seventy-two patients underwent adrenalectomy at HVC and 91\r\nat LVC. The two groups were homogeneous for age, sex, clinical presentation, and \r\nstage. The mean lesions size of ACC was higher in HVC than in LVC (104.1 ± 54.6\r\nvs 82.8 ± 41.3 mm; P < 0.001). A significantly higher rate of lymph node\r\ndissection (P < 0.01) and of multiorgan resection (P < 0.01) was accomplished in \r\nHVC. The number of patients who underwent adjuvant therapy was significantly\r\nhigher in HVC (P < 0.001). Local recurrence rate was lower in patients treated at\r\nHVC (6% vs 18.5%; P = NS). Mean time to recurrence was significantly longer in\r\nHVC than in LVC (25.2 ± 28.1 vs 10.1 ± 7.5; P < 0.01).\r\nCONCLUSION: The expertise of dedicated centers had a positive impact on the\r\noutcome of patients with ACC, resulting in a lower recurrence rate and improved\r\nmean time to recurrence. The improved patient outcome could be related not only\r\nto the appropriateness of the surgical procedure, but also to a more adequate\r\nmultidisciplinary approach.