Masha Livhits1, Ning Li2, Michael W Yeh1, Avital Harari3. 1. Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA. 2. Department of Biomathematics, University of California, Los Angeles, Los Angeles, CA. 3. Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA. Electronic address: aharari@mednet.ucla.edu.
Abstract
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare but lethal tumor. Predictors of survival include earlier stage at presentation and complete operative resection. We assessed effect of treatment and demographic variables on survival. METHODS: ACC cases were abstracted from the California Cancer Registry and Office of Statewide Health Planning and Development (1999-2008). Predictors included patient demographics, comorbidities, tumor size, stage, and treatment (none, surgery, chemotherapy and/or radiation [CRT], and surgery plus CRT). RESULTS: We studied 367 patients with median tumor size of 10 cm. At presentation, 37% had localized, 17% had regional, and 46% had metastatic disease. Median survival was 1.7 years (7.4 years local, 2.6 years regional, and 0.3 years metastatic, P < .0001). One-year and 5-year survival was: 92%/62% (local); 73%/39% (regional); and 24%/7% (metastatic). Increased age (hazard ratio [HR] 1.16) and Cushing's syndrome (HR 1.66) worsened survival (P < .05). Low socioeconomic status worsened survival in local and regional disease (P < .05). In multivariable regression, both surgery (regional HR 0.13; metastatic HR 0.52) and surgery plus CRT (regional HR 0.15; metastatic HR 0.31) improved survival compared with no treatment (P < .02). CONCLUSION: In ACC, surgery is associated with improved survival, even in metastatic disease. Surgery should be considered for select patients as part of multimodality treatment.
BACKGROUND:Adrenocortical carcinoma (ACC) is a rare but lethal tumor. Predictors of survival include earlier stage at presentation and complete operative resection. We assessed effect of treatment and demographic variables on survival. METHODS: ACC cases were abstracted from the California Cancer Registry and Office of Statewide Health Planning and Development (1999-2008). Predictors included patient demographics, comorbidities, tumor size, stage, and treatment (none, surgery, chemotherapy and/or radiation [CRT], and surgery plus CRT). RESULTS: We studied 367 patients with median tumor size of 10 cm. At presentation, 37% had localized, 17% had regional, and 46% had metastatic disease. Median survival was 1.7 years (7.4 years local, 2.6 years regional, and 0.3 years metastatic, P < .0001). One-year and 5-year survival was: 92%/62% (local); 73%/39% (regional); and 24%/7% (metastatic). Increased age (hazard ratio [HR] 1.16) and Cushing's syndrome (HR 1.66) worsened survival (P < .05). Low socioeconomic status worsened survival in local and regional disease (P < .05). In multivariable regression, both surgery (regional HR 0.13; metastatic HR 0.52) and surgery plus CRT (regional HR 0.15; metastatic HR 0.31) improved survival compared with no treatment (P < .02). CONCLUSION: In ACC, surgery is associated with improved survival, even in metastatic disease. Surgery should be considered for select patients as part of multimodality treatment.
Authors: D E Schteingart; G M Doherty; P G Gauger; T J Giordano; G D Hammer; M Korobkin; F P Worden Journal: Endocr Relat Cancer Date: 2005-09 Impact factor: 5.678
Authors: Christine J O'Neill; Andrew Spence; Barney Logan; James W Suliburk; Patsy S Soon; Diana L Learoyd; Stan B Sidhu; Mark S Sywak Journal: J Surg Oncol Date: 2010-10-01 Impact factor: 3.454
Authors: B Lauren Paton; Yuri W Novitsky; Marc Zerey; Andrew G Harrell; H James Norton; Horatio Asbun; Kent W Kercher; B Todd Heniford Journal: Surgery Date: 2006-10-19 Impact factor: 3.982
Authors: Benzon M Dy; Kevin B Wise; Melanie L Richards; William F Young; Clive S Grant; Keith C Bible; Jordan Rosedahl; William S Harmsen; David R Farley; Geoffrey B Thompson Journal: Surgery Date: 2013-12 Impact factor: 3.982
Authors: J P Luton; S Cerdas; L Billaud; G Thomas; B Guilhaume; X Bertagna; M H Laudat; A Louvel; Y Chapuis; P Blondeau Journal: N Engl J Med Date: 1990-04-26 Impact factor: 91.245
Authors: Caroline E Poorman; Lauren M Postlewait; Cecilia G Ethun; Thuy B Tran; Jason D Prescott; Timothy M Pawlik; Tracy S Wang; Jason Glenn; Ioannis Hatzaras; Rivfka Shenoy; John E Phay; Kara Keplinger; Ryan C Fields; Linda X Jin; Sharon M Weber; Ahmed Salem; Jason K Sicklick; Shady Gad; Adam C Yopp; John C Mansour; Quan-Yang Duh; Natalie Seiser; Carmen C Solorzano; Colleen M Kiernan; Konstantinos I Votanopoulos; Edward A Levine; Charles A Staley; George A Poultsides; Shishir K Maithel Journal: Am Surg Date: 2017-07-01 Impact factor: 0.688
Authors: Caroline E Poorman; Cecilia G Ethun; Lauren M Postlewait; Thuy B Tran; Jason D Prescott; Timothy M Pawlik; Tracy S Wang; Jason Glenn; Ioannis Hatzaras; Rivfka Shenoy; John E Phay; Kara Keplinger; Ryan C Fields; Linda X Jin; Sharon M Weber; Ahmed Salem; Jason K Sicklick; Shady Gad; Adam C Yopp; John C Mansour; Quan-Yang Duh; Natalie Seiser; Carmen C Solórzano; Colleen M Kiernan; Konstantinos I Votanopoulos; Edward A Levine; Charles A Staley; George A Poultsides; Shishir K Maithel Journal: Ann Surg Oncol Date: 2017-11-21 Impact factor: 5.344
Authors: Georgios Antonios Margonis; Yuhree Kim; Jason D Prescott; Thuy B Tran; Lauren M Postlewait; Shishir K Maithel; Tracy S Wang; Douglas B Evans; Ioannis Hatzaras; Rivfka Shenoy; John E Phay; Kara Keplinger; Ryan C Fields; Linda X Jin; Sharon M Weber; Ahmed Salem; Jason K Sicklick; Shady Gad; Adam C Yopp; John C Mansour; Quan-Yang Duh; Natalie Seiser; Carmen C Solorzano; Colleen M Kiernan; Konstantinos I Votanopoulos; Edward A Levine; George A Poultsides; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2015-08-19 Impact factor: 5.344
Authors: M H T Ettaieb; J C Duker; R A Feelders; E P M Corssmit; C W Menke-van der Houven van Oordt; H J L M Timmers; M N Kerstens; J W Wilmink; P M Zelissen; B Havekes; H R Haak Journal: Horm Cancer Date: 2016-07-15 Impact factor: 3.869
Authors: Paula Marincola Smith; Colleen M Kiernan; Thuy B Tran; Lauren M Postlewait; Shishir K Maithel; Jason Prescott; Timothy Pawlik; Tracy S Wang; Jason Glenn; Ioannis Hatzaras; Rivka Shenoy; John Phay; Lawrence A Shirley; Ryan C Fields; Linda Jin; Sharon Weber; Ahmed Salem; Jason Sicklick; Shady Gad; Adam Yopp; John Mansour; Quan-Yang Duh; Natalie Seiser; Konstantinos Votanopoulos; Edward A Levine; George Poultsides; Carmen C Solórzano Journal: Ann Surg Oncol Date: 2018-06-04 Impact factor: 5.344
Authors: Yun Mi Choi; Hyemi Kwon; Min Ji Jeon; Tae-Yon Sung; Suck Joon Hong; Tae Yong Kim; Won Bae Kim; Young Kee Shong; Jae Lyun Lee; Dong Eun Song; Won Gu Kim Journal: Medicine (Baltimore) Date: 2016-05 Impact factor: 1.889