Abstract | November 18, 2023

Adrenal Carcinoma Laterality is of Limited Clinical Significance: A National Perspective

Charlotte Pecot, BA, Tulane University School of Medicine, New Orleans, LA

Mohammad Hussein, MD, MSc, Medical Research Technician, Department of Surgery, Tulane University School of Medicine, New Orleans, LA; Peter P. Issa, BS, LSUHSC School of Medicine, New Orleans, LA; Tessa R. Lavorgna, BS, Tulane University School of Medicine, New Orleans, LA; Chad P. Issa, BS, LSUHSC School of Medicine, New Orleans, LA; Lauren Mueller, BA, Tulane University School of Medicine, New Orleans, LA; Eman Toraih, MD, MSc, PhD, Assistant Research Professor, Department of Surgery, Tulane University School of Medicine, New Orleans, LA

Learning Objectives

  1. Describe the previously hypothesized detection bias affecting laterality of adrenal tumors
  2. Discuss the impact of laterality on the prognosis of adrenal; compare/contrast this to its impact in cancers of other paired organs

Introduction/Background:
Adrenal cancers are rare and aggressive malignancies. The most common adrenal malignancies include adrenocortical carcinoma (ACC) and pheochromocytoma (of the adrenal medulla). Like other endocrine cancer, adrenal tumors tend to present more commonly in women and, intriguingly, display laterality.

Methods:
A retrospective cohort study was performed using the National Cancer Database (2004–2013). This database covers 70% of all newly diagnosed cases across Commission on Cancer (CoC)-accredited facilities in the United States (US). The data includes demographic and clinical characteristics, histopathological type, cancer staging, administered treatment modalities, and outcomes information.

Results:
A total of 3962 patients were included in the final analysis, of which 1870 (47.2%) had right-sided and 2092 (52.8%) had left-sided adrenal tumors. The mean age of the population was 56.1 ± 15.8 years old and 57.0% were female. To analyze the influence of adrenal tumor laterality, a sub-group analysis was performed on patients with right vs. left-sided tumors. Patients with tumors on the right and left side had similar means ages of 56.1 ± 15.7 and 56.2 ± 16.0, respectively (p=0.87). Left-sided tumors occurred more commonly in female (58.5% vs 55.4%, p=0.05) and White patients (89.2% vs 86.8%, p=0.02). Primary cancer site and tumor grade was similar in both cohorts. Left sidedness was associated with larger tumor size (105 mm vs 98 mm, p=0.037), distant organ metastasis (38.5% vs 31.7%, p=0.028), especially to the lung (21.1% vs 17.0%, p=0.038). Right-sidedness was associated with more advanced T stage (p=0.002) and distant lymph node metastasis (2.1% vs 0.9%, p=0.013). There was no difference in survival between right and left-sided tumors (p=0.0.129).

Conclusions:
Previous studies have proposed that left-sided adrenal tumors are more likely to be visualized by radiologists and surgeons, creating a detection bias for left-sided adrenal tumors. Our study suggests that this detection bias is limited and does not affect tumor staging, presence of metastasis, or prognosis at time of discovery. Our findings suggest that laterality of adrenal tumors is not indicative of tumor staging or survivability and that tumor grade remains a significant predictor of mortality.

References and Resources

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Posted in: Surgery & Surgical Specialties67
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