Victor Srougi1,2, Irina Bancos3, Marilyne Daher4, Jeffrey E Lee5, Paul H Graham5, Jose A Karam6, Andres Henriquez3, Travis J Mckenzie3,7, Alaa Sada3,7, Isabelle Bourdeau8, Jonathan Poirier8, Anand Vaidya9, Tiffany Abbondanza9, Colleen M Kiernan10, Sarika N Rao11, Oksana Hamidi12, Nirupa Sachithanandan13, Ana O Hoff14, Jose L Chambo1, Madson Q Almeida14,15, Mouhammed Amir Habra4, Maria C B V Fragoso14,15. 1. Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 2. Division of Urology, Hospital Moriah, São Paulo, Brazil. 3. Division of Endocrinology, Mayo Clinic, Rochester, MN, USA. 4. Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Urology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Surgery, Mayo Clinic, Rochester, MN, USA. 8. Division of Endocrinology and Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada. 9. Center for Adrenal Disorders, Division of Endocrinology Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 10. Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 11. Division of Endocrinology, Mayo Clinic, Jacksonville, FL, USA. 12. Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX, USA. 13. Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia. 14. Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 15. Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Abstract
CONTEXT: The role of cytoreduction of adrenocortical carcinoma (ACC) remains poorly understood. OBJECTIVE: To analyze the impact of cytoreductive surgery of the primary tumor in patients with metastatic ACC. DESIGN AND SETTING: We performed a multicentric, retrospective paired cohort study comparing the overall survival (OS) in patients with metastatic ACC who were treated either with cytoreductive surgery (CR group) or without cytoreductive surgery (no-CR group) of the primary tumor. Data were retrieved from 9 referral centers in the American-Australian-Asian Adrenal Alliance collaborative research group. PATIENTS: Patients aged ≥18 years with metastatic ACC at initial presentation who were treated between January 1, 1995, and May 31, 2019. INTERVENTION: Performance (or not) of cytoreductive surgery of the primary tumor. MAIN OUTCOME AND MEASURES: A propensity score match was done using age and the number of organs with metastasis (≤2 or >2). The main outcome was OS, determined from the date of diagnosis until death or until last follow-up for living patients. RESULTS: Of 339 patients pooled, 239 were paired and included: 128 in the CR group and 111 in the no-CR group. The mean follow-up was 67 months. Patients in the no-CR group had greater risk of death than did patients in the CR group (hazard ratio [HR] = 3.18; 95% CI, 2.34-4.32). Independent predictors of survival included age (HR = 1.02; 95% CI, 1.00-1.03), hormone excess (HR = 2.56; 95% CI, 1.66-3.92), and local metastasis therapy (HR = 0.41; 95% CI, 0.47-0.65). CONCLUSION: Cytoreductive surgery of the primary tumor in patients with metastatic ACC is associated with prolonged survival.
CONTEXT: The role of cytoreduction of adrenocortical carcinoma (ACC) remains poorly understood. OBJECTIVE: To analyze the impact of cytoreductive surgery of the primary tumor in patients with metastatic ACC. DESIGN AND SETTING: We performed a multicentric, retrospective paired cohort study comparing the overall survival (OS) in patients with metastatic ACC who were treated either with cytoreductive surgery (CR group) or without cytoreductive surgery (no-CR group) of the primary tumor. Data were retrieved from 9 referral centers in the American-Australian-Asian Adrenal Alliance collaborative research group. PATIENTS: Patients aged ≥18 years with metastatic ACC at initial presentation who were treated between January 1, 1995, and May 31, 2019. INTERVENTION: Performance (or not) of cytoreductive surgery of the primary tumor. MAIN OUTCOME AND MEASURES: A propensity score match was done using age and the number of organs with metastasis (≤2 or >2). The main outcome was OS, determined from the date of diagnosis until death or until last follow-up for living patients. RESULTS: Of 339 patients pooled, 239 were paired and included: 128 in the CR group and 111 in the no-CR group. The mean follow-up was 67 months. Patients in the no-CR group had greater risk of death than did patients in the CR group (hazard ratio [HR] = 3.18; 95% CI, 2.34-4.32). Independent predictors of survival included age (HR = 1.02; 95% CI, 1.00-1.03), hormone excess (HR = 2.56; 95% CI, 1.66-3.92), and local metastasis therapy (HR = 0.41; 95% CI, 0.47-0.65). CONCLUSION: Cytoreductive surgery of the primary tumor in patients with metastatic ACC is associated with prolonged survival.
Authors: Brian K Bednarski; Mouhammed Amir Habra; Alexandria Phan; Denai R Milton; Christopher Wood; Nicholas Vauthey; Douglas B Evans; Matthew H Katz; Chaan S Ng; Nancy D Perrier; Jeffrey E Lee; Elizabeth G Grubbs Journal: World J Surg Date: 2014-06 Impact factor: 3.352
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Authors: Judit Tőke; Andrea Uhlyarik; Júlia Lohinszky; Júlia Stark; Gergely Huszty; Tamás Micsik; Katalin Borka; Péter Reismann; János Horányi; Peter Igaz; Miklós Tóth Journal: Front Endocrinol (Lausanne) Date: 2022-09-29 Impact factor: 6.055