Katherine M Prendergast1, Paula Marincola Smith2, Thuy B Tran3, Lauren M Postlewait4, Shishir K Maithel4, Jason D Prescott5, Timothy M Pawlik5, Tracy S Wang6, Jason Glenn6, Ioannis Hatzaras7, Rivfka Shenoy7, John E Phay8, Lawrence A Shirley8, Ryan C Fields9, Linda X Jin9, Sharon M Weber10, Ahmed Salem10, Jason K Sicklick11, Shady Gad11, Adam C Yopp12, John C Mansour12, Quan-Yang Duh13, Natalie Seiser13, Konstantinos I Votanopoulos14, Edward A Levine14, George A Poultsides3, Carmen C Solórzano2, Colleen M Kiernan15. 1. Vanderbilt University School of Medicine, Nashville, TN. 2. Department of Surgery, Vanderbilt University, Nashville, TN. 3. Department of Surgery, Stanford University School of Medicine, Stanford, CA. 4. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA. 5. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. 6. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 7. Department of Surgery, New York University School of Medicine, New York, NY. 8. Department of Surgery, The Ohio State University, Columbus, OH. 9. Department of Surgery, Washington University School of Medicine, St Louis, MO. 10. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 11. Department of Surgery, University of California San Diego, San Diego, CA. 12. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. 13. Department of Surgery, University of California San Francisco, San Francisco, CA. 14. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC. 15. Department of Surgery, Vanderbilt University, Nashville, TN. Electronic address: colleenkiernan@gmail.com.
Abstract
BACKGROUND: Adrenocortical carcinoma is a rare, aggressive cancer. We compared features of patients who underwent synchronous versus metachronous metastasectomy. METHODS: Adult patients who underwent resection for metastatic adrenocortical carcinoma from 1993 to 2014 at 13 institutions of the US adrenocortical carcinoma group were analyzed retrospectively. Patients were categorized as synchronous if they underwent metastasectomy at the index adrenalectomy or metachronous if they underwent resection after recurrence of the disease. Factors associated with overall survival were assessed by univariate analysis. RESULTS: In the study, 84 patients with adrenocortical carcinoma underwent metastasectomy; 26 (31%) were synchronous and 58 (69%) were metachronous. Demographics were similar between groups. The synchronous group had more T4 tumors at the index resection (42 vs 3%, P < .001). The metachronous group had prolonged median survival after the index resection (86.3 vs 17.3 months, P < .001) and metastasectomy (36.9 vs 17.3 months, P = .007). Synchronous patients with R0 resections had improved survival compared to patients with R1/2 resections (P = .008). Margin status at metachronous metastasectomy was not associated with survival (P = .452). CONCLUSION: Select patients with metastatic adrenocortical carcinoma may benefit from metastasectomy. Patients with metachronous metastasectomy have a more durable survival benefit than those undergoing synchronous metastasectomy. This study highlights need for future studies examining differences in tumor biology that could explain outcome disparities in these distinct patient populations.
BACKGROUND:Adrenocortical carcinoma is a rare, aggressive cancer. We compared features of patients who underwent synchronous versus metachronous metastasectomy. METHODS: Adult patients who underwent resection for metastatic adrenocortical carcinoma from 1993 to 2014 at 13 institutions of the US adrenocortical carcinoma group were analyzed retrospectively. Patients were categorized as synchronous if they underwent metastasectomy at the index adrenalectomy or metachronous if they underwent resection after recurrence of the disease. Factors associated with overall survival were assessed by univariate analysis. RESULTS: In the study, 84 patients with adrenocortical carcinoma underwent metastasectomy; 26 (31%) were synchronous and 58 (69%) were metachronous. Demographics were similar between groups. The synchronous group had more T4 tumors at the index resection (42 vs 3%, P < .001). The metachronous group had prolonged median survival after the index resection (86.3 vs 17.3 months, P < .001) and metastasectomy (36.9 vs 17.3 months, P = .007). Synchronous patients with R0 resections had improved survival compared to patients with R1/2 resections (P = .008). Margin status at metachronous metastasectomy was not associated with survival (P = .452). CONCLUSION: Select patients with metastatic adrenocortical carcinoma may benefit from metastasectomy. Patients with metachronous metastasectomy have a more durable survival benefit than those undergoing synchronous metastasectomy. This study highlights need for future studies examining differences in tumor biology that could explain outcome disparities in these distinct patient populations.
Authors: Jordan J Baechle; Paula Marincola Smith; Carmen C Solórzano; Thuy B Tran; Lauren M Postlewait; Shishir K Maithel; Jason Prescott; Timothy Pawlik; Tracy S Wang; Jason Glenn; Ioannis Hatzaras; Rivfka Shenoy; John E Phay; Lawrence A Shirley; Ryan C Fields; Linda Jin; Daniel E Abbott; Sean Ronnekleiv-Kelly; Jason K Sicklick; Adam Yopp; John Mansour; Quan-Yang Duh; Natalie Seiser; Konstantinos Votanopoulos; Edward A Levine; George Poultsides; Colleen M Kiernan Journal: Ann Surg Oncol Date: 2021-02-14 Impact factor: 5.344
Authors: Jordan J Baechle; David N Hanna; Konjeti R Sekhar; Jeffrey C Rathmell; W Kimryn Rathmell; Naira Baregamian Journal: J Cell Mol Med Date: 2021-10-19 Impact factor: 5.310