title: Preoperative adrenal biopsy does not affect overall survival in adrenocortical carcinoma.
abstract: BACKGROUND
  The impact of preoperative biopsy on overall survival (OS) in adrenocortical carcinoma (ACC) is unclear. We analyzed the National Cancer Data Base (NCDB) for factors associated with preoperative adrenal biopsy and its effect on OS in ACC.
  
  
  METHODS
  The NCDB was queried from 2003 to 2012 for M0 ACC. Patients with or without preoperative biopsy were compared for factors associated with an increased rate of biopsy. Survival analysis was performed after adjusting for patient and tumor-related variables.
  
  
  RESULTS
  There were 1782 patients with M0 ACC of whom 332 (19%) had a preoperative biopsy. Treatment outside academic cancer centers (OR 1.36, 95% CI 1.04-1.77, P = 0.023) and male gender (OR 1.45, 95% CI 1.11-1.88, P = 0.006) were associated with an increased rate of biopsy. In patients undergoing adrenalectomy with negative margins, biopsy failed to impact OS (log-rank P = 0.225, HR 1.20, 95% CI 0.84-1.72, P = 0.306).
  
  
  CONCLUSIONS
  Preoperative adrenal biopsy continues to be performed for ACC with no added survival benefit. Adrenalectomy offers the best chance of survival in patients with ACC.
authors.affiliation: Department of Surgery, NorthShore University Health System, Baptist Health Medical Group, Evanston, IL, USA. Electronic address: suman.paritosh@gmail.com.
authors.forename: Paritosh
authors.initials: P
authors.lastname: Suman
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Calcatera
authors.affiliation: Research Institute, NorthShore University Health System, Evanston, IL, USA.
authors.forename: Chi-Hsiung
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL, USA.
authors.forename: Tricia A
authors.initials: TA
authors.lastname: Moo-Young
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prinz
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate