Endocrine Abstracts

Introduction: Carcinoma of the adrenal cortex (ACC) is a rare disease with an estimated incidence of 1–2 per 1 million population. Optimal treatment of ACC is multidisciplinary and has complex aspects such as adrenal surgery, adjuvant therapy with mitotane and cytotoxic chemotherapy in advanced stages. The Dutch Adrenal Network (DAN), a collaboration between all university centers and Máxima Medical Center, was founded with the objective of improving patient care and stimulating scientific research regarding ACC. Currently, not all patients with ACC are treated in such a specialized DAN-center. The objective of our current investigation is to determine whether there are differences in survival between patients operated on in DAN-centers and non-DAN hospitals.

Methods: Data on all adult ACC patients diagnosed between 1999 and 2009 were obtained from The Netherlands Cancer Registry (NCR). Overall survival was calculated and a comparison was made between DAN- and non-DAN hospitals.

Results: The registry contained data on 191 patients, ACC was histologically confirmed in 185 patients (97%). Median survival was significantly different between patients with ENS@T disease stage I-III operated on in a DAN hospital (n=40) compared to patients operated on in a non-DAN hospital (n=33, median survival not reached versus 45 months (95% CI 16–74 months), P=0.026). This difference remained significant when corrected for gender, age, year of diagnosis, chemotherapy and stage of disease in multivariate analysis (P=0.026, hazard ratio 0.44 (95% CI 0.21–0.90)).

Conclusion: The results display that surgery in a DAN-center yields a survival benefit for patients with local or locally advanced adrenocortical carcinoma. These findings should be carefully considered in the strive for further centralization of ACC-treatment in The Netherlands.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.