Faculty Collaboration Database

Recurrence of adrenal cortical carcinoma following resection: surgery alone can achieve results equal to surgery plus mitotane. Ann Surg Oncol 2010 Jan;17(1):263-70

Date

10/24/2009

Pubmed ID

19851811

DOI

10.1245/s10434-009-0716-x

Scopus ID

2-s2.0-74649087201 (requires institutional sign-in at Scopus site)   134 Citations

Abstract

BACKGROUND: A recent nonrandomized interinstitutional study reported that adjuvant mitotane following surgery for adrenocortical carcinoma (ACC) was associated with decreased recurrence. Because of the limitations of this study, we investigated the influences of surgery and adjuvant mitotane in a large series of ACC patients evaluated and treated at a single referral center.

STUDY DESIGN: Retrospective evaluation of patients followed at a single institution after surgery for ACC.

RESULTS: 218 patients with ACC underwent primary resection either at the index institution [surgery index (SI), n = 28] or an outside institution [surgery outside (SO), n = 190] and had a median follow-up of 88 months. SI patients had a superior disease-free survival compared with SO patients (median 25 versus 12 months, P = 0.003), and SI patients also had a superior overall survival compared with SO patients (median not reached versus 44 months, P = 0.02). Factors predicting increased risk of recurrence on multivariate analysis were surgery at an outside institution [hazard ratio (HR) 2.56, 95% confidence interval (CI) 1.44-4.53, P = 0.001] and no treatment with adjuvant mitotane (HR 1.95, 95% CI 1.06-3.59, P = 0.03), and those predicting a poorer survival were advanced stage at presentation (P = 0.01) and surgery at an outside institution (HR 2.62, 95% CI 1.31-5.25, P = 0.007).

CONCLUSIONS: The recurrence rate of the index group (50%) in the current series, the overwhelming majority of whom did not receive adjuvant mitotane, is indistinguishable from that reported for those who received adjuvant mitotane (49%) in the recent interinstitutional report, emphasizing the importance of completeness of initial surgery in the management of patients with ACC.

Author List

Grubbs EG, Callender GG, Xing Y, Perrier ND, Evans DB, Phan AT, Lee JE

Authors

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Alexandria T. Phan MD Professor in the Medicine department at Medical College of Wisconsin

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

Adolescent
Adrenal Cortex Neoplasms
Adrenocortical Carcinoma
Adult
Aged
Antineoplastic Agents, Hormonal
Chemotherapy, Adjuvant
Child
Child, Preschool
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mitotane
Neoplasm Recurrence, Local
Neoplasm Staging
Retrospective Studies
Survival Rate
Treatment Outcome
Young Adult