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. 2023 Jan 4:13:1029155.
doi: 10.3389/fgene.2022.1029155. eCollection 2022.

The prognosis difference between elderly and younger patients with adrenocortical carcinoma

Shengyin He  1 , Xuemei Huang  2 , Pan Zhao  2 , Peng Zhang  3
Affiliations

The prognosis difference between elderly and younger patients with adrenocortical carcinoma

Shengyin He et al. Front Genet. .

Abstract

Background and aim: Adrenocortical carcinoma (ACC) is uncommon in the elderly. This study aimed to compare the surgical prognosis and survival between senior and younger patients. We also explored the factors that were independently related to the survival of elderly patients. Methods: We identified ACC patients between 2010 and 2019 in the Surveillance, Epidemiology, and End Results (SEER) database and applied Kaplan-Meier curves to evaluate the overall survival (OS) and cancer-specific survival (CSS) with log-rank tests. We also used Cox regression analysis to estimate the OS and CSS. The Fine and Gray model with the Gray test was used to measure the cumulative incidence function (CIF) of CSS and other mortality causes of patients in a competing-risks setting. Results: Of 876 patients, 44.06% were elderly. A lower proportion of elderly patients underwent surgery, regional lymph node surgery, and chemotherapy than young patients. Elderly patients also had inferior OS and CSS than younger patients. The 1- and 5-year OS of elderly patients who underwent surgery were 68% [95% confidence interval (CI): 62%-74%] and 30% (95% CI: 24%-38%), and the 1- and 5-year CSS were 73% (95% CI: 67%-80%) and 40% (95% CI: 32%-47%). The factors independently related to worsened survival included age ≥60 [Hazard Ratio (HR): 1.47 (1.24-1.75)], metastatic disease [HR: 1.90 (1.49-2.51)], higher grade [HR: 1.94 (1.08-3.46)] and Network for the Study of Adrenal Tumors (ENSAT) stage [HR: 1.99 (1.48-2.66)]. Conclusion: Younger ACC patients had better survival than the elderly. Factors independently related to worsened survival in elderly patients included age ≥60, metastatic disease, higher grade, and European ENSAT stage.

Keywords: SEER; adrenocortical carcinoma; elderly; prognosis; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The ACC patients was divided into younger and elderly patients by the X-tile software.
FIGURE 2
FIGURE 2
Kaplan-Meier survival curves for (A) OS and (B) CSS in ACC patients, according to age groups.
FIGURE 3
FIGURE 3
Kaplan-Meier survival curves for (A) OS and (B) CSS in ACC patients received surgery, according to age groups.
FIGURE 4
FIGURE 4
CSS and non-CSS cumulative incidence function curves based on the age groups. The black line represents non-cancer-specific death, the black dashed line represents elderly patients, the black solid line represents young patients, and the black dashed line above the black solid line represents the non-cancer-specific death rate of elderly patients with prolongation of survival time. The probability is higher than that of younger patients. The red line represents cancer-specific death, the red dashed line represents elderly patients, the red solid line represents younger patients, and the red dashed line above the red solid line represents that as the survival time increases, the probability of cancer-specific death in elderly patients is higher than that in younger patients.
See this image and copyright information in PMC

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