Endocrine/Head and Neck
non-CME
Jesse E. Passman, MD, MPH (he/him/his)
Resident Physician
Department of Surgery, University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Jesse E. Passman, MD, MPH (he/him/his)
Resident Physician
Department of Surgery, University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Sara P. Ginzberg, MD (she/her/hers)
Resident Physician
Hospital of the University of Pennsylvania, Pennsylvania, United States
Disclosure information not submitted.
Wajid Amjad, BS
Research Specialist
University of Pennsylvania Health System, United States
Disclosure information not submitted.
Jacqueline M. Soegaard Ballester, MD, MBMI
Resident Physician
Department of Surgery, University of Pennsylvania Health System, United States
Disclosure information not submitted.
Heather Wachtel, MD (she/her/hers)
Assistant Professor of Surgery
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Disclosure(s): No financial relationships to disclose
We performed a retrospective cohort study of patients with metastatic ACC using the National Cancer Database (2010-2019). Subjects were categorized by surgical management received: resection of the primary tumor with or without metastasectomy, metastasectomy only, or no surgery. Multivariable Cox proportional hazards regression was used to assess the association between patient and tumor characteristics, type of surgical resection, medical therapies, and survival.
Results:
Of 1,198 subjects who presented with metastatic ACC, 60.3% were female and 75.5% were non-Hispanic White. Mean age was 55.9±15.6 years. Patients who received surgery were younger (53.5 vs. 57.4 years, p< 0.001) and a greater proportion were privately insured (p=0.001). Median survival varied significantly between patients who did not receive surgery (4.4 months, 95% CI: 3.9, 5.0), those who underwent resection of the primary tumor only (16.3, 95% CI: 13.2, 19.3; p< 0.001), those who underwent metastasectomy only (6.4, 95% CI: 3.8, 13.0; p=0.040), and those who underwent resection of primary and metastasectomy (15.3, 95% CI: 10.1, 24.1; p< 0.001) (Figure). There was no significant difference in median survival between patients who underwent resection of the primary tumor only and those who underwent resection of the primary tumor and metastasectomy (p=0.730).
In the multivariate model, resection of the primary tumor (HR: 0.202, 95% CI: 0.122, 0.337; p< 0.001) and resection of the primary and metastasectomy (HR: 0.367, 95% CI: 0.210, 0.641; p< 0.001) were associated with improved survival, but metastasectomy alone was not (HR: 0.352, 95% CI: 0.035, 3.500; p=0.373). Chemotherapy (HR: 0.449, 95% CI: 0.295, 0.681; p< 0.001), radiation therapy (HR: 0.522, 95% CI: 0.335, 0.812; p=0.004), and hormonal therapy (HR: 0.203, 95% CI: 0.056, 0.734; p=0.015) were also associated with improved survival.
Conclusions:
In patients with metastatic ACC, surgical resection of the primary tumor is associated with improved survival when compared to non-operative management after controlling for tumor differentiation, though this finding is limited by the potential for selection bias. Adjuvant chemo- and radiation therapy are also associated with longer survival, but metastasectomy alone is not.