Thuy B Tran1, Shishir K Maithel2, Timothy M Pawlik3, Tracy S Wang4, Ioannis Hatzaras5, John E Phay6, Ryan C Fields7, Sharon M Weber8, Jason K Sicklick9, Adam C Yopp10, Quan-Yang Duh11, Carmen C Solorzano12, Konstantinos I Votanopoulos13, George A Poultsides14. 1. Department of Surgery, Stanford University, Stanford, CA. 2. Department of Surgery, Emory University, Atlanta, GA. 3. Department of Surgery, The Johns Hopkins University, Baltimore, MD. 4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 5. Department of Surgery, New York University, New York, NY. 6. Department of Surgery, The Ohio State University, Columbus, OH. 7. Department of Surgery, Washington University, St Louis, MO. 8. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 9. Department of Surgery, University of California San Diego, San Diego, CA. 10. Department of Surgery, University of Texas Southwestern, Dallas, TX. 11. Department of Surgery, University of California San Francisco, San Francisco, CA. 12. Department of Surgery, Vanderbilt University, Nashville, TN. 13. Department of Surgery, Wake Forest University, Winston-Salem, NC. 14. Department of Surgery, Stanford University, Stanford, CA. Electronic address: gpoultsides@stanford.edu.
Abstract
BACKGROUND: Adrenocortical carcinoma (ACC) is an aggressive malignancy typically resistant to chemotherapy and radiation. Surgery, even in the setting of locally recurrent or metastatic disease, remains the only potentially curative option. However, the subset of patients who will benefit from repeat resection in this setting remains ill defined. The objective of this study was to propose a prognostic clinical score that facilitates selection of patients for repeat resection of recurrent ACC. STUDY DESIGN: Patients who underwent curative-intent repeat resection for recurrent ACC at 1 of 13 academic medical centers participating in the US ACC Study Group were identified. End points included morbidity, mortality, and overall survival. RESULTS: Fifty-six patients underwent repeat curative-intent resection for recurrent ACC (representing 21% of 265 patients who underwent resection for primary ACC) from 1997 to 2014. Median age was 52 years. Sites of resected recurrence included locoregional only (54%), lung only (14%), liver only (12%), combined locoregional and lung (4%), combined liver and lung (4%), and other distant sites (12%). Thirty-day morbidity and mortality rates were 40% and 5.4%, respectively. Cox regression analysis revealed that the presence of multifocal recurrence, disease-free interval <12 months, and extrapulmonary distant metastases were independent predictors of poor survival. A clinical score consisting of 1-point each for the 3 variables demonstrated good discrimination in predicting survival after repeat resection (5-year: 72% for 0 points, 32% for 1 point, 0% for 2 or 3 points; p = 0.0006, area under the curve = 0.78). CONCLUSIONS: Long-term survival after repeat resection for recurrent ACC is feasible when 2 of the following factors are present: solitary tumor, disease-free interval >12 months, and locoregional or pulmonary recurrence.
BACKGROUND:Adrenocortical carcinoma (ACC) is an aggressive malignancy typically resistant to chemotherapy and radiation. Surgery, even in the setting of locally recurrent or metastatic disease, remains the only potentially curative option. However, the subset of patients who will benefit from repeat resection in this setting remains ill defined. The objective of this study was to propose a prognostic clinical score that facilitates selection of patients for repeat resection of recurrent ACC. STUDY DESIGN:Patients who underwent curative-intent repeat resection for recurrent ACC at 1 of 13 academic medical centers participating in the US ACC Study Group were identified. End points included morbidity, mortality, and overall survival. RESULTS: Fifty-six patients underwent repeat curative-intent resection for recurrent ACC (representing 21% of 265 patients who underwent resection for primary ACC) from 1997 to 2014. Median age was 52 years. Sites of resected recurrence included locoregional only (54%), lung only (14%), liver only (12%), combined locoregional and lung (4%), combined liver and lung (4%), and other distant sites (12%). Thirty-day morbidity and mortality rates were 40% and 5.4%, respectively. Cox regression analysis revealed that the presence of multifocal recurrence, disease-free interval <12 months, and extrapulmonary distant metastases were independent predictors of poor survival. A clinical score consisting of 1-point each for the 3 variables demonstrated good discrimination in predicting survival after repeat resection (5-year: 72% for 0 points, 32% for 1 point, 0% for 2 or 3 points; p = 0.0006, area under the curve = 0.78). CONCLUSIONS: Long-term survival after repeat resection for recurrent ACC is feasible when 2 of the following factors are present: solitary tumor, disease-free interval >12 months, and locoregional or pulmonary recurrence.
Authors: Jan op den Winkel; Joachim Pfannschmidt; Thomas Muley; Christiane Grünewald; Hendrik Dienemann; Martin Fassnacht; Bruno Allolio Journal: Ann Thorac Surg Date: 2011-10-13 Impact factor: 4.330
Authors: Nicole M Datrice; Russell C Langan; R Taylor Ripley; Clinton D Kemp; Seth M Steinberg; Bradford J Wood; Steven K Libutti; Tito Fojo; David S Schrump; Itzhak Avital Journal: J Surg Oncol Date: 2011-12-20 Impact factor: 3.454
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: Ilknur Erdogan; Timo Deutschbein; Christian Jurowich; Matthias Kroiss; Christina Ronchi; Marcus Quinkler; Jens Waldmann; Holger S Willenberg; Felix Beuschlein; Christian Fottner; Silke Klose; Anke Heidemeier; David Brix; Wiebke Fenske; Stefanie Hahner; Joachim Reibetanz; Bruno Allolio; Martin Fassnacht Journal: J Clin Endocrinol Metab Date: 2012-11-12 Impact factor: 5.958
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: 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: J Am Coll Surg Date: 2015-12-21 Impact factor: 6.113
Authors: Karl Y Bilimoria; Wen T Shen; Dina Elaraj; David J Bentrem; David J Winchester; Electron Kebebew; Cord Sturgeon Journal: Cancer Date: 2008-12-01 Impact factor: 6.860
Authors: Winifred Lo; Reed I Ayabe; Christine M Kariya; Meghan L Good; Seth M Steinberg; Jeremy L Davis; Robert T Ripley; Jonathan M Hernandez Journal: J Surg Oncol Date: 2019-12-06 Impact factor: 2.885