Risk factors associated with positive resection margins in patients with adrenocortical carcinoma

Am J Surg. 2020 Oct;220(4):932-937. doi: 10.1016/j.amjsurg.2020.02.043. Epub 2020 Feb 22.


Background: Positive resection margins are associated with worse survival after surgery for adrenocortical carcinoma (ACC). We aimed to identify risk factors for positive margins post-resection.

Methods: The NCDB was queried for ACC patients from 2006 to 2015. Patients with positive versus negative resection margins post-surgery were compared using Chi-square tests. Survival based on adjuvant treatment was assessed using Kaplan-Meier curves.

Results: 1,973 patients with ACC were identified, 217 (11.0%) with positive margins. Multivariable analysis identified extra-adrenal extension (HR 4.92, p < 0.001), lymph node metastases (HR 2.64, p = 0.001), and distant metastases (HR 1.53, p = 0.03) as risk factors for positive margins. No significant difference in margin status existed between patients who had an open versus minimally invasive procedure (p = 0.6). Positive margin patients receiving adjuvant radiation (p = 0.007) or combined chemo-radiation (p = 0.001) had the longest survival.

Conclusion: No modifiable risk factors were identified, but patients with positive margins receiving adjuvant radiation or chemo-radiation had the longest survival.

Keywords: Adrenocortical carcinoma; Positive margins; Risk factors.

MeSH terms

  • Adrenal Cortex Neoplasms / diagnosis
  • Adrenal Cortex Neoplasms / surgery*
  • Adrenocortical Carcinoma / mortality
  • Adrenocortical Carcinoma / secondary
  • Adrenocortical Carcinoma / surgery*
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Lymphatic Metastasis
  • Male
  • Margins of Excision*
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • United States / epidemiology