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01-01-2016 | Endocrine Tumors

Curative Resection of Adrenocortical Carcinoma: Rates and Patterns of Postoperative Recurrence

Authors: Neda Amini, MD, Georgios Antonios Margonis, MD, PhD, Yuhree Kim, MD, MPH, Thuy B. Tran, MD, Lauren M. Postlewait, MD, Shishir K. Maithel, MD, Tracy S. Wang, MD, MPH, Douglas B. Evans, MD, Ioannis Hatzaras, MD, MPH, Rivfka Shenoy, MD, John E. Phay, MD, Kara Keplinger, MD, Ryan C. Fields, MD, Linda X. Jin, MD, Sharon M. Weber, MD, Ahmed Salem, MD, Jason K. Sicklick, MD, Shady Gad, MD, Adam C. Yopp, MD, John C. Mansour, MD, Quan-Yang Duh, MD, Natalie Seiser, MD, PhD, Carmen C. Solorzano, MD, Colleen M. Kiernan, MD, Konstantinos I. Votanopoulos, MD, Edward A. Levine, MD, George A. Poultsides, MD, Timothy M. Pawlik, MD, MPH, PhD

Published in: Annals of Surgical Oncology | Issue 1/2016

Abstract

Background

Adrenocortical carcinoma (ACC) is a rare malignancy. The aim of this study was to determine the incidence and patterns of recurrence after curative-intent surgery for ACC.

Methods

Patients who underwent curative-intent resection for ACC between 1993 and 2014 were identified from 13 academic institutions participating in the United States ACC study group. Patients with metastasis or an R2 margin were excluded. Patterns and rates of recurrence were determined and classified as locoregional and distant recurrence.

Results

A total of 180 patients with a median age of 52 years (interquartile range 43–61) were identified. Most patients underwent open surgery (n = 111, 64.5 %) and had an R0 resection margin (n = 117, 75.0 %). At last follow-up, 116 patients (64.4 %) had experienced recurrence (locoregional only, n = 41, 36.3 %; distant only, n = 51, 45.1 %; locoregional and distant, n = 21, 18.6 %). Median time to recurrence was 18.8 months. Several factors were associated with locoregional recurrence, including left-sided ACC location (odds ratio [OR] 2.71, 95 % confidence interval [CI] 1.06–6.89) and T3/T4 disease (reference T1/T2, OR 3.04, 95 % CI 1.19–7.80) (both p < 0.05). Distant recurrence was associated with larger tumor size (OR 1.11, 95 % CI 1.01–1.24) and T3/T4 disease (reference T1/T2, OR 5.23, 95 % CI 1.70–16.10) (both p < 0.05). Patients with combined locoregional and distant recurrence had worse survival (3- and 5-year survival: 39.5, 19.7 %) versus patients with distant-only (3- and 5-year survival 55.1, 43.3 %) or locoregional-only recurrence (3- and 5-year survival 81.4, 64.1 %) (p = 0.01).

Conclusions

Nearly two-thirds of patients experienced disease recurrence after resection of ACC. Although a subset of patients experienced recurrence with locoregional disease only, many patients experienced recurrence with distant disease as a component of recurrence and had a poor prognosis.

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Title: Curative Resection of Adrenocortical Carcinoma: Rates and Patterns of Postoperative Recurrence
Authors: Neda Amini, MD
Georgios Antonios Margonis, MD, PhD
Yuhree Kim, MD, MPH
Thuy B. Tran, MD
Lauren M. Postlewait, MD
Shishir K. Maithel, MD
Tracy S. Wang, MD, MPH
Douglas B. Evans, MD
Ioannis Hatzaras, MD, MPH
Rivfka Shenoy, MD
John E. Phay, MD
Kara Keplinger, MD
Ryan C. Fields, MD
Linda X. Jin, MD
Sharon M. Weber, MD
Ahmed Salem, MD
Jason K. Sicklick, MD
Shady Gad, MD
Adam C. Yopp, MD
John C. Mansour, MD
Quan-Yang Duh, MD
Natalie Seiser, MD, PhD
Carmen C. Solorzano, MD
Colleen M. Kiernan, MD
Konstantinos I. Votanopoulos, MD
Edward A. Levine, MD
George A. Poultsides, MD
Timothy M. Pawlik, MD, MPH, PhD
Publication date: 01-01-2016
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 1/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4810-y

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Springer Medicine

Curative Resection of Adrenocortical Carcinoma: Rates and Patterns of Postoperative Recurrence

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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