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Adrenal (Excluding Mineralocorticoids)

MON-538 - Is Surgery an Independent Predictor of Cancer-Specific Survival for Patients with Adrenal Pheochromocytoma?

Monday, June 15, 2026
9:00 AM - 2:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Mohamed Farrag, MBBCH , MSc: No financial relationships to disclose
Background
Pheochromocytoma is a rare adrenal tumour, and distant metastasis is rare. Surgical resection is the standard of care for localised disease. Emerging evidence supports surgery in selected patients with metastatic disease. This study aimed to evaluate the association between surgical resection and cancer-specific survival (CSS) and to identify the independent predictors of CSS for adrenal pheochromocytoma.

Methods
A total of 613 adult patients with adrenal pheochromocytoma (diagnosed 2012-2022) were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier (KM) plots for CSS and the log-rank test (LR) were generated for the surgery and no surgery groups. Univariable and multivariable Fine-Gray (FG) analyses for CSS were performed.

Results
Median age was 58 years, and most patients were female (54.8%), white (55.5%), and living in metropolitan areas (89.6%). Median size was 41 mm. Most tumours were localized (70.3%), and only 9.8% had distant metastasis. Most patients had surgery (80.1%). Patients who underwent surgery were younger, had smaller tumours, and had mostly localised disease (77.8%). Sex, race, rurality, and income were similar between the surgery and the no surgery group. Only 43.3% of patients with distant metastases underwent surgical resection.

CSS at 12, 36, 60, and 120 months were 95.2%, 88.6%, 80.7%, and 70.1%, respectively. The KM plot and LR tests showed that surgery had a better CSS than no surgery in all patients (p < 0.001) and even in patients with distant metastasis (p=0.009). Multivariable FG analysis for all patients showed that larger tumours, advanced stage, and not undergoing surgery are associated with worse CSS.

Conclusion
Surgical resection is associated with better CSS in patients with pheochromocytoma, even when distant metastases are present. Larger tumours, advanced stage, and not undergoing surgery were associated with worse CSS. Future prospective studies should investigate the role of surgery in the management of metastatic pheochromocytoma and identify which patients are suitable for surgery, while addressing SEER's limitations, including inaccurate and missing data on comorbidities and genetic and molecular markers.

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