肾上腺皮质癌（ACC）是一种侵袭性、致命的恶性肿瘤。切除仍然是主要治疗方法；然而，关于手术的最佳方法和范围以及辅助治疗的作用，存在相互矛盾的证据。我们评估了手术技术和辅助治疗对非转移性 ACC 生存的影响。我们利用国家癌症数据库对 2010 年至 2019 年间接受非转移性 ACC 手术的受试者进行了一项回顾性队列研究。主要结果是总体生存率。 Cox 比例风险模型的开发是为了确定临床和治疗特征与生存之间的关联。总共包括 1175 名受试者。他们的平均年龄为 54±15 岁，其中 62% 的患者是女性。 67% 的手术通过开放手术进行，22% 涉及多器官切除，26% 包括淋巴结切除术。中位生存期为 77.1 个月。年龄（风险比[HR] 1.019；p < 0.001）、晚期（III期HR 2.421；p < 0.001）、腹腔镜手术（HR 1.329；p = 0.010）和阳性切缘（HR 1.587；p < 0.001）与生存呈负相关，而切除范围（HR 1.189；p = 0.140）和淋巴结清扫术（HR 1.039；p = 0.759）则没有相关性。按分期分层，腹腔镜切除仅与 III 期疾病的较差生存率相关（HR 1.548；p = 0.007）。放化疗仅与切缘阳性患者的生存率改善相关（HR 0.475；p = 0.004）。肿瘤生物学和手术切缘是非转移性 ACC 生存的主要决定因素。手术范围和淋巴结清扫术与总生存率无关。在晚期疾病中，开放式方法与提高生存率相关。© 2023。外科肿瘤学会。

Adrenocortical carcinoma (ACC) is an aggressive, deadly malignancy. Resection remains the primary treatment; however, there is conflicting evidence regarding the optimal approach to and extent of surgery and the role of adjuvant therapy. We evaluated the impact of surgical technique and adjuvant therapies on survival in non-metastatic ACC.We performed a retrospective cohort study of subjects who underwent surgery for non-metastatic ACC between 2010 and 2019 utilizing the National Cancer Database. The primary outcome was overall survival. Cox proportional hazards models were developed to identify associations between clinical and treatment characteristics and survival.Overall, 1175 subjects were included. Their mean age was 54 ± 15 years, and 62% of patients were female. 67% of procedures were performed via the open approach, 22% involved multi-organ resection, and 26% included lymphadenectomy. Median survival was 77.1 months. Age (hazard ratio [HR] 1.019; p < 0.001), advanced stage (stage III HR 2.421; p < 0.001), laparoscopic approach (HR 1.329; p = 0.010), and positive margins (HR 1.587; p < 0.001) were negatively associated with survival, while extent of resection (HR 1.189; p = 0.140) and lymphadenectomy (HR 1.039; p = 0.759) had no association. Stratified by stage, laparoscopic resection was only associated with worse survival in stage III disease (HR 1.548; p = 0.007). Chemoradiation was only associated with improved survival in patients with positive resection margins (HR 0.475; p = 0.004).Tumor biology and surgical margins are the primary determinants of survival in non-metastatic ACC. Surgical extent and lymphadenectomy are not associated with overall survival. In advanced disease, the open approach is associated with improved survival.© 2023. Society of Surgical Oncology.