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TREATMENT DIFFERENCES AT HIGH VOLUME CENTERS AND LOW VOLUME CENTERS IN NON-METASTATIC AND METASTATIC ADRENOCORTICAL CARCINOMA
E MacKinney, S Holoubek, A Khokar, K Kuchta, T Moo-Young, R Prinz, D Winchester
NorthShore University HealthSystem

Background
Adrenocortical Carcinoma (ACC) is rare with poor survival. We sought to determine if treatment and outcomes varied by hospital case volume.

Methods
ACC patients were identified from the NCDB (2004-2017). High-volume centers (HVCs) were defined by ?15 adrenal malignancies and low-volume centers by ? 7 over 14 years. Multivariable Cox and logistic regression analysis were performed for non-metastatic (NM-ACC) and metastatic ACC patients (M-ACC).

Results
1,918 patients were from 787 LVCS and 1053 were from 42 HVCs. LVCs had 1,229 NM-ACC and 689 M-ACC. HVCs had 725 NM-ACC and 328 M-ACC. NM-ACCC treated at HVCs compared to LVCs were younger (5315 vs. 5816 years), more likely to have tumors ?10 cm (48.3 vs. 40.9%), have surgery (93.1 vs. 80.6%), regional lymph node evaluation (23.9 vs. 17.5%), and chemotherapy (35.3 vs. 23.6%, all p<0.05). On multivariable analysis, both NM-ACC and M-ACC patients at HVCs were more likely to have surgery [HR=2.36 (95% CI 1.88-2.96)], chemotherapy [HR=1.60 (95% CI 1.35-1.89)], and less likely to be readmitted. On a multivariable analysis of NM-ACC patients having surgery, HVCs were more likely than LVCs to administer chemotherapy [HR=1.58 (95% CI 1.25-1.98) p <0.001] but there was no difference in overall survival (OS), number of nodes examined, 90-day mortality, 30-day readmission, length of stay, or radiation administered for positive margins. Patients having surgery for M-ACC at HVCs had improved OS [HR 0.72 (95% CI 0.53-0.98) p=0.0342], more chemotherapy [HR 1.99 (95% CI 1.16-3.43) p=0.0130], lower 90-Day mortality [HR 0.38 (95% CI 0.17- 0.84) p=0.017), and less adjuvant radiation administration for positive margins (5.7% to 23.3% p=0.0327).

Conclusion
Both NM-ACC and M-ACC treated at HVCs were more likely to have an operation and multimodality therapy than those at LVCs. NM-ACC having surgery at HVCs and LVCs had similar OS. M-ACC at HVCs had improved 90-day mortality and OS.


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