ELSEVIER
Surgery
journal homepage: www.elsevier.com/locate/surg
SURGERY
NOVEMBER 2018
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Operative intervention for recurrence of adrenocortical carcinoma: A single-center experience
Fan Zhang, MD, Zhihong Liu, MD, Jiayu Liang, MD, Yongquan Tang, MD, Shenzhuo Liu, MD, Chuan Zhou, MD, Fuxun Zhang, MD, Kan Wu, MD, Yiping Lu, MD, Xianding Wang, MD*
Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
ARTICLE INFO
Article history: Accepted 31 October 2020 Available online xxx
ABSTRACT
Introduction: Adrenocortical carcinoma is a rare endocrine malignancy with a high recurrence rate. The aim of this study was to evaluate the role of surgery for patients with local or distant recurrent adre- nocortical carcinoma and to attempt to identify prognostic features related to survival benefit in patients undergoing resection of recurrence.
Methods: The data of 47 patients with recurrent adrenocortical carcinoma in West China Hospital, Sichuan, China, between 2009 and 2019 were retrospectively collected. These patients were divided into 2 groups according to whether resection of recurrence was performed. The correlation between overall survival after recurrence and reoperation was evaluated. Kaplan-Meier and univariate/multivariate Cox regression methods were used to identify any prognostic factors.
Results: Included in our study were 21 patients who underwent reoperation and 26 patients who un- derwent nonoperative treatments were. The operation group had a better median overall survival after recurrence than the nonoperation group (19 months versus 6.5 months; P =. 007). In the operated group, disease-free interval >12 months (P = . 002), complete resection of recurrent adrenocortical carcinoma (P = . 041), and RO resection of the primary tumor (P = . 005) were associated with prolonged survival after recurrence.
Conclusions: Reoperation plays an important role in the management of selected patients with recurrent adrenocortical carcinoma. Disease-free interval, preoperative evaluation for complete resection, and R0 resection of the primary tumor are important prognostic characteristics for the resection of recurrent adrenocortical carcinoma. The overall survival after recurrence was significantly improved for patients who had a disease-free interval >12 months, and initial R0 resection or complete resection of recurrent adrenocortical carcinoma is feasible.
@ 2020 Elsevier Inc. All rights reserved.
Introduction
Adrenocortical carcinoma (ACC), although a rare endocrine malignancy with an annual incidence of 1 to 2 per million in- habitants, has one of the poorest prognoses, with a preponderance in females compared with men (1.5:1).1,2 Approximately 40% to 60% of patients have hormone excess symptoms attributable to func- tional tumors, most of which are Cushing syndrome. The remaining patients with nonfunctional tumors are always asymptomatic, and tumors may become quite large until discovery attributable to symptoms of mass effect.3 Because patients usually present with
large primary tumors with invasion of adjacent organs or meta- static disease, the prognosis of ACC is extremely poor. The overall 5- year survival rate is less than 50%. Furthermore, the 5-year survival rate of patients with metastatic ACC is less than 20%.4,5
Patients with ACC, compared with other types of tumors, do not benefit from the improvement of global tumor treatments. Evidence demonstrates that chemotherapy and radiation therapy are inef- fective in most cases of ACC. Mitotane, a drug that is currently the only medication approved by the Food and Drug Administration for ACC, is usually only temporarily effective, and its use is often asso- ciated with significant side effects, including potential disturbances of the metabolism of hormones and drugs.6,7 Complete tumor resection is still the only curative treatment.8,9 Therefore, with the current uncertain therapeutic effects, restrictions on toxic drugs and the high risk of disease recurrence, the clinical management of ACC remains a challenge for researchers worldwide.
Fan Zhang, Zhihong Liu, and Jiayu Liang are first coauthors.
* Reprint requests: Xianding Wang, MD, Sichuan University West China Hospital, Department of Urology, Sichuan University, Chengdu 610041, China.
E-mail address: xiandingwang@qq.com (X. Wang).