title: Treatment patterns and outcomes for patients with adrenocortical carcinoma associated with hospital case volume in the United States.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) is a rare, aggressive disease with no apparent change in treatment or survival in the United States over the past two decades. Our objective was to determine whether treatment patterns or clinical outcomes vary by hospital case volume.
  
  
  METHODS
  Patients with ACC were identified from the National Cancer Database (1998-2011). High-volume centers (HVCs) were defined by a case load of ≥4 cases of primary adrenal malignancy annually, which corresponded to the 90th percentile. All other facilities were considered low-volume centers (LVCs).
  
  
  RESULTS
  A total of 2,765 ACC patients were treated across 1,046 facilities. Compared to patients treated at LVCs, patients treated at HVCs were younger (50 vs. 54 years), with larger tumors (11.2 vs. 10.5 cm), and underwent higher rates of surgery (78.8 vs. 73.4 %), radical resection (17.3 vs. 13.9 %), regional lymph node evaluation (23.2 vs. 18.8 %), and chemotherapy including mitotane (43.8 vs. 31.0 %, all p < 0.05).There were no significant differences in median length of stay (5 vs. 5 days), 30-day readmission rates (4.0 % for HVCs vs. 3.9 % for LVCs), or 30-day postoperative mortality rates (1.9 % for HVCs vs. 3.7 % for LVCs). Median overall survival was 2.0 years for HVCs and 1.9 years for LVCs, p = 0.53. After adjusting for patient and tumor characteristics, overall survival did not differ significantly between patients treated at HVCs versus LVCs [HR = 0.89 (95 % confidence interval 0.70, 1.12)].
  
  
  CONCLUSIONS
  Treatment at HVCs was associated with more aggressive surgical resection and chemotherapy use. Prognosis remained poor despite more aggressive treatment.
authors: Division of Endocrinology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors: Lauren
authors: L
authors: Gratian
authors: John
authors: J
authors: Pura
authors: Michaela
authors: M
authors: Dinan
authors: Shelby
authors: S
authors: Reed
authors: Randall
authors: R
authors: Scheri
authors: Sanziana
authors: S
authors: Roman
authors: Julie Ann
authors: JA
authors: Sosa
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018268:Adrenocortical Carcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D016526:Workload