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Outcomes after resection of cortisol-secreting adrenocortical carcinoma. Am J Surg 2016 Jun;211(6):1106-13

Date

01/27/2016

Pubmed ID

26810939

Pubmed Central ID

PMC4957943

DOI

10.1016/j.amjsurg.2015.09.020

Scopus ID

2-s2.0-84956956561 (requires institutional sign-in at Scopus site)   39 Citations

Abstract

BACKGROUND: We sought to define the impact of cortisol-secreting status on outcomes after surgical resection of adrenocortical carcinoma (ACC).

METHODS: The U.S ACC group database was queried to identify patients who underwent ACC resection between 1993 and 2014. The short-term and long-term outcomes were assessed.

RESULTS: The incidence of all functional and cortisol-secreting tumors was 40.6% and 22.6%, respectively. On multivariable analysis, cortisol secretion remained associated with an increased risk of postoperative complications (odds ratio = 2.25, 95 % confidence interval = 1.04 to 4.88; P = .04). At a median follow-up of 17.6 months, 118 patients (50.4%) had developed a recurrence. On multivariable analysis, after adjusting for patient and disease-related factors cortisol secretion independently predicted shorter recurrence-free survival (Hazard ratio = 2.05, 95% confidence interval = 1.16 to 3.60; P = .01).

CONCLUSIONS: Cortisol secretion was associated with an increased risk of postoperative morbidity. Recurrence remains high among patients with ACC after surgery; cortisol secretion was independently associated with a shorter recurrence-free survival. Tailoring postoperative surveillance of ACC patients based on their cortisol secreting status may be important.

Author List

Margonis GA, Kim Y, Tran TB, Postlewait LM, Maithel SK, Wang TS, Glenn JA, Hatzaras I, Shenoy R, Phay JE, Keplinger K, Fields RC, Jin LX, Weber SM, Salem A, Sicklick JK, Gad S, Yopp AC, Mansour JC, Duh QY, Seiser N, Solorzano CC, Kiernan CM, Votanopoulos KI, Levine EA, Poultsides GA, Pawlik TM

Author

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adrenal Cortex Neoplasms
Adrenalectomy
Adrenocortical Carcinoma
Adult
Analysis of Variance
Cause of Death
Databases, Factual
Disease-Free Survival
Female
Humans
Hydrocortisone
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Postoperative Complications
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome