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Objectives: To test for an association between oncological risk factors and overall survival in patients with non-metastatic adrenocortical carcinoma treated with adjuvant radiation therapy at high-risk for recurrence per NCCN guidelines., Materials and Methods: We analyzed data from patients undergoing surgical resection with or without aRT in the NCDB from 2004 to 2017. A multivariable Cox proportional hazards model was fit to assess for an association of aRT and OS. To determine whether aRT was associated with improved OS in patients with specific NCCN risk factors, we fit three multivariable Cox proportional hazard models with an interaction term between NCCN risk factors and the use of aRT., Results: We identified 1,433 patients treated surgically for adrenocortical carcinoma with at least one risk factor. 259 patients received adjuvant radiation therapy (18%) while 1,174 (82%) patients did not. After adjustment, we noted a significant association between adjuvant radiation therapy and overall survival in the entire cohort in the multivariable Cox proportional hazards model (HR 0.68, 95% CI 0.55-0.85, P = 0.001). Adjuvant radiation therapy was associated with increased overall survival in patients with positive surgical margins (HR 0.47, 95% CI 0.35-0.65, P < 0.001), large tumor size ≥6 cm (HR 0.69, 95% CI 0.55-0.87, P = 0.002), and high-grade disease (HR 0.61, 95% CI 0.37-0.99, P = 0.046)., Conclusions: Patients with ACC at high-risk for recurrence were associated with improved overall survival when treated with adjuvant radiation therapy. These data may help identify which patients should consider aRT after resection of clinically localized ACC., Competing Interests: Conflicts of Interest Kevin Ginsburg certifies that all authors do not have any direct or indirection conflicts of interest pertaining to this manuscript., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: Inguinal lymphadenectomy remains under performed in patients with invasive penile cancer. Using a large national cancer registry we assessed temporal trends in inguinal lymphadenectomy performance and evaluated the impact of the procedure on survival in patients in whom inguinal lymphadenectomy was an absolute indication (T1b-4 N0/x-1) according to NCCN ® (National Comprehensive Cancer Network®) Guidelines®., Materials and Methods: We queried the National Cancer Database for all cases of nonmetastatic, T1b-4 N0/x-1 squamous cell carcinoma of the penis from 2004 to 2014. Multivariable logistic regression models adjusting for patient, demographic, and clinicopathological characteristics were used to examine the association between available covariates and receipt of inguinal lymphadenectomy. Cox proportional hazards regression analysis was then done to assess the impact of clinical and pathological variables on overall survival. Propensity score weighted analysis was performed to assess the effect of inguinal lymphadenectomy on overall survival., Results: A total of 2,224 patients met analysis criteria, of whom 606 (27.2%) underwent inguinal lymphadenectomy. Following adjustment the procedure was more likely in younger patients, those who presented with palpable adenopathy (cN1), those treated at an academic facility and those with a more contemporary diagnosis. On survival analysis controlling for all known and measured confounders inguinal lymphadenectomy was associated with improved overall survival (HR 0.79, 95% CI 0.74-0.84, p <0.001)., Conclusions: At hospitals that report to the National Cancer Database the overall rate of inguinal lymphadenectomy in patients with invasive penile cancer was only 27.2%. Inguinal lymphadenectomy was associated with increased overall survival, justifying the procedure as an important quality metric for performance reporting in patients with invasive penile cancer., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

This paper takes a market-oriented approach to study potential exposure of methylmercury (MeHg) risk to human health from US domestic commercial ocean fish landings (consumption). Information is assembled on MeHg concentration levels of marine species. Landings were examined for 1995-2005. Confined to this seafood source, trends of landings indicating high concentration species (above 0.7 ppm, tilefish, shark, king mackerel and swordfish) were significantly decreased. People bought stable amount of medium MeHg level species (0.3-0.7 ppm, grouper, Spanish mackerel) but less amount of low concentration level species (below 0.3 ppm, catfish, tuna and southern flounder). Based on estimated prices of species and quantities taken it is found that consumers, one crucial link of the entire MeHg risk assessment process, had exhibited awareness of potential MeHg risk in fish and demonstrated in household fish consumption. Information assembled in this paper is insufficient to draw further inference on specific population cohorts more susceptible to potential exposure of MeHg risk. This inquiry may be extended to imported fish in the US for comparison.