Georgios Antonios Margonis1, Yuhree Kim1, Thuy B Tran2, Lauren M Postlewait3, Shishir K Maithel3, Tracy S Wang4, Jason A Glenn4, Ioannis Hatzaras5, Rivfka Shenoy5, John E Phay6, Kara Keplinger6, Ryan C Fields7, Linda X Jin7, Sharon M Weber8, Ahmed Salem8, Jason K Sicklick9, Shady Gad9, Adam C Yopp10, John C Mansour10, Quan-Yang Duh11, Natalie Seiser11, Carmen C Solorzano12, Colleen M Kiernan12, Konstantinos I Votanopoulos13, Edward A Levine13, George A Poultsides2, Timothy M Pawlik14. 1. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. 2. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA. 3. Department of Surgery, Emory University, Atlanta, GA, USA. 4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 5. Department of Surgery, New York University School of Medicine, New York, NY, USA. 6. Department of Surgery, The Ohio State University, Columbus, OH, USA. 7. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 8. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 9. Department of Surgery, University of California San Diego, San Diego, CA, USA. 10. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 11. Department of Surgery, University of California San Francisco, San Francisco, CA, USA. 12. Department of Surgery, Vanderbilt University, Nashville, TN, USA. 13. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. 14. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. Electronic address: tpawlik1@jhmi.edu.
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.
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.
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