Abstract 34P
Background
Whether environmental pollution may influence adrenocortical carcinoma (ACC) development remains largely unknown. The aim of this study was to evaluate the impact of exposition to environmental pollutants on ACC presentation and prognosis in Italy.
Methods
A retrospective analysis was done on 500 patients affected by ACC, who were diagnosed in 12 reference centers in Italy from 1990 to 2018 and followed-up for a median of 37.5 months (interquartile range, IQR, 11-83). Patients were stratified according to: i) residence in Sites of National Interest (SIN) which are areas with contaminated soil and water, classified as dangerous by the Italian Ministry of Environment and in need of remediation; ii) residence in areas with different degrees of urbanisation, considered as index of exposure to air pollution.
Results
At diagnosis, 50 (10%) patients were resident in SIN (Res-SIN) and 450 (90%) patients were not (Not-SIN). The two groups had similar characteristics in terms of age, ENSAT stage, tumor size, Weiss score and Ki67%. However, incidental diagnosis of ACC was more frequent in Not-SIN patients (40.0% vs 19.6%; p=0.011). Res-SIN patients showed shorter recurrence-free survival (RFS) (21 months vs 41 months; p=0.027). In multivariate analysis, residence in SIN was an independent negative prognostic factor for RFS (HR 1.82, 95%CI 1.10-3.03; p=0.021). Overall survival (OS) showed a similar pattern although the difference between the 2 groups was not significantly different. At diagnosis, 205 (41%) patients were resident in “cities” (> 50% of population in urban centers, with density >1,500 inhabitants/km2 and population >50,000), 230 (46%) in “towns/suburbs” (>50% in urban clusters with density >300 inhabitants/km2 and population >5,000), and 65 (13%) in “rural areas” (> 50% of population not meeting the previous criteria). No statistically significant differences were observed among the 3 groups in terms of clinical presentation, RFS and OS.
Conclusions
The different clinical presentation and worse outcome of ACC in patients living in areas with contaminated soil and water suggest that environmental pollutants in these matrices may have a role in conditioning the behavior of this rare tumor. Conversely, air pollution does not seem to influence the ACC disease course.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.