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

• Type of Material: Article
• Authors: Neda Amini, Johns Hopkins University; Georgios Antonios Margonis, Johns Hopkins University; Yuhree Kim, Johns Hopkins University; Thuy B. Tran, Stanford University; Lauren M. Postlewait, Emory University; Shishir Maithel, Emory University; Tracy S. Wang, Medical College of Wisconsin; Douglas B. Evans, Medical College of Wisconsin; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; John E. Phay, Ohio State University; Kara Keplinger, Ohio State University; Ryan C. Fields, Washington University; Linda X. Jin, Washington University; Sharon M. Weber, University of Wisconsin; Ahmed Salem, University of Wisconsin; Jason K. Sicklick, University of California San Diego; Shady Gad, University of California San Diego; Adam C. Yopp, University of Texas; John C. Mansour, University of Texas; Quan-Yang Duh, University of California San Francisco; Natalie Seiser, University of California San Francisco; Carmen C. Solorzano, Vanderbilt University; Colleen M. Kiernan, Vanderbilt University; Konstantinos I. Votanopoulos, Wake Forest School of Medicine; Edward A. Levine, Wake Forest School of Medicine; George A. Poultsides, Stanford University; Timothy M Pawlik, Johns Hopkins University
• Language: English
• Date: 2016-01-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015, Society of Surgical Oncology.
• Final Published Version (URL): http://dx.doi.org/10.1245/s10434-015-4810-y
• Title of Journal or Parent Work: Annals of Surgical Oncology
• ISSN: 1068-9265
• Volume: 23
• Issue: 1
• Start Page: 126
• End Page: 133
• Keywords: FEATURES; PROGNOSTIC-FACTORS; ADRENAL-CORTICAL CARCINOMA; SURVIVAL; EXPERIENCE; UNITED-STATES; Surgery; CANCER; OUTCOMES; Oncology; ENDOCRINE; Science & Technology; Life Sciences & Biomedicine; MANAGEMENT
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

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.