title: Association of tumor size with metastatic potential and survival in patients with adrenocortical carcinoma: an analysis of the National Cancer Database.
abstract: BACKGROUND
  To assess the impact of size at presentation in patients with adrenocortical carcinoma (ACC) on rates of synchronous metastatic disease and survival following resection using a large administrative dataset.
  
  
  METHODS
  We queried the National Cancer Database (NCDB) dataset to assemble a cohort of patients with ACC based on SEER staging (1985-2000). Patients were stratified into three groups based on surgical tumor size cutoffs: < 4 cm, 4 cm-6 cm, and > 6 cm. Rates of metastatic disease at presentation in all ACC patients as well as relative survival for patients after resection of localized lesions were calculated and compared among groups.
  
  
  RESULTS
  A total of 2248 patients had available staging information for analysis. Tumor size at presentation did not relate to likelihood of non-localized disease at presentation (p = 0.09). A restricted cubic splines analysis revealed a clinically insignificant relationship between tumor size and advanced disease at presentation (OR = 1.02 for each centimeter change in tumor size, p = 0.004, 95% CI 1.01-1.03). On multivariate analysis, only patient age (p < 0.01), and not tumor size, was a significant predictor of overall survival among patients undergoing resection of localized ACCs.
  
  
  CONCLUSIONS
  Our data suggest that tumor size is imperfect in predicting presence of distant disease at presentation, nor does it consistently correlate with patient survival after resection of localized ACC.
authors.affiliation: Emory University, Atlanta, Georgia, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Canter
authors.forename: Katherine
authors.initials: K
authors.lastname: Mallin
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: Brian L
authors.initials: BL
authors.lastname: Egleston
authors.forename: Jay
authors.initials: J
authors.lastname: Simhan
authors.forename: John
authors.initials: J
authors.lastname: Walton
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000401:mortality / Q000473:pathology*; D018268:Adrenocortical Carcinoma / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis / Q000175:diagnosis* / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate; D055815:Young Adult