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

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Conflict of interest

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Author information

Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Neda Amini MD, Georgios Antonios Margonis MD, PhD, Yuhree Kim MD, MPH & Timothy M. Pawlik MD, MPH, PhD

  2. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Thuy B. Tran MD & George A. Poultsides MD

  3. Department of Surgery, Emory University, Atlanta, GA, USA

    Lauren M. Postlewait MD & Shishir K. Maithel MD

  4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Tracy S. Wang MD, MPH & Douglas B. Evans MD

  5. Department of Surgery, New York University School of Medicine, New York, NY, USA

    Ioannis Hatzaras MD, MPH & Rivfka Shenoy MD

  6. Department of Surgery, The Ohio State University, Columbus, OH, USA

    John E. Phay MD & Kara Keplinger MD

  7. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ryan C. Fields MD & Linda X. Jin MD

  8. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD & Ahmed Salem MD

  9. Department of Surgery, University of California San Diego, San Diego, CA, USA

    Jason K. Sicklick MD & Shady Gad MD

  10. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Adam C. Yopp MD & John C. Mansour MD

  11. Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Quan-Yang Duh MD & Natalie Seiser MD, PhD

  12. Department of Surgery, Vanderbilt University, Nashville, TN, USA

    Carmen C. Solorzano MD & Colleen M. Kiernan MD

  13. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos MD & Edward A. Levine MD

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  1. Neda Amini MD
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  2. Georgios Antonios Margonis MD, PhD
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  3. Yuhree Kim MD, MPH
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  4. Thuy B. Tran MD
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  5. Lauren M. Postlewait MD
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  6. Shishir K. Maithel MD
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  7. Tracy S. Wang MD, MPH
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  8. Douglas B. Evans MD
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  9. Ioannis Hatzaras MD, MPH
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  10. Rivfka Shenoy MD
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  11. John E. Phay MD
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  12. Kara Keplinger MD
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  13. Ryan C. Fields MD
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  14. Linda X. Jin MD
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  15. Sharon M. Weber MD
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  16. Ahmed Salem MD
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  17. Jason K. Sicklick MD
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  18. Shady Gad MD
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  19. Adam C. Yopp MD
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  20. John C. Mansour MD
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  21. Quan-Yang Duh MD
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  22. Natalie Seiser MD, PhD
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  23. Carmen C. Solorzano MD
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  24. Colleen M. Kiernan MD
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  25. Konstantinos I. Votanopoulos MD
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  26. Edward A. Levine MD
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  27. George A. Poultsides MD
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  28. Timothy M. Pawlik MD, MPH, PhD
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Amini, N., Margonis, G.A., Kim, Y. et al. Curative Resection of Adrenocortical Carcinoma: Rates and Patterns of Postoperative Recurrence. Ann Surg Oncol 23, 126–133 (2016). https://doi.org/10.1245/s10434-015-4810-y

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  • DOI: https://doi.org/10.1245/s10434-015-4810-y

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