Adrenal cortical carcinoma

Venkatesh, Swamy; Hickey, Robert C.; Sellin, Rena V.; Fernández, José María Díaz; Samaan, Naguib A.

doi:10.1002/1097-0142(19890801)64:3<765::aid-cncr2820640333>3.0.co;2-i

Cited by 184 publications

(107 citation statements)

References 12 publications

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“…Other authors have previously suggested a similar favourable effect (Hutter & Kayhoe, 1966b;Lubitz et al, 1973;Venkatesh et al, 1989), but to our knowledge this has never been well documented. Moreover, in a large retrospective study Luton et al (1990) could not find an independent beneficial effect resulting from mitotane therapy.…”

Section: Discussionsupporting

confidence: 58%

“…Adjuvant mitotane therapy has been advocated after complete tumour resection (Venkatesh et al, 1989;Luton et al, 1990). In our study, patients who were treated adjuvantly with mitotane did not do better than those who did not receive it.…”

Section: Discussionmentioning

confidence: 99%

“…Carcinoma of the adrenal cortex carries a poor prognosis (Macfarlane, 1958;Hutter & Kayhoe, 1966a;Venkatesh et al, 1989;Luton et al, 1990). According to recently reported clinical studies, only 20-25% of patients survive for more than 5 years after the diagnosis is made (Venkatesh et al, 1989;Luton et al, 1990).…”

mentioning

confidence: 99%

“…According to recently reported clinical studies, only 20-25% of patients survive for more than 5 years after the diagnosis is made (Venkatesh et al, 1989;Luton et al, 1990). Early diagnosis and radical surgery offer the best hope for long-term survival.…”

mentioning

confidence: 99%

“…Mitotane (o,p'-DDD) is considered to be the drug of choice for patients with inoperable, recurrent and metastatic disease (Samaan & Hickey, 1987). Increase in survival (Hutter & Kayhoe, 1966b;Lubitz et al, 1973;Venkatesh et al, 1989) and even long-term remission and cure of adrenocortical cancer (Becker & Schumacher, 1975;Jarabak & Rice, 1981) have been attributed to mitotane. Unfortunately, because of the rarity of the tumour, no randomised or controlled studies have been performed to assess mitotane's effect on patients' survival in adrenocortical carcinoma.…”

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confidence: 99%

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Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients

Haak

Hermans²,

Cj³

et al. 1994

Br J Cancer

306

229

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Summary Mitotane is considered to be the drug of choice for patients with inoperable, recurrent and metastatic adrenocortical carcinoma, although a favourable effect of this drug on survival has never been documented. We evaluated the efficacy of mitotane treatment of 96 patients with adrenocortical carcinoma followed up in our department between 1959 and 1992. Complete tumour resection was the goal of the initial treatment. Mitotane treatment was classified according to serum trough concentrations on maintenance therapy: low (<14mgl-') or high (>14mg1-'). Total tumour resection was feasible in 47 patients (49%), and subtotal resection was performed in 37 patients (39%). Patients who underwent total tumour resection survived significantly longer than those who did not (P<0.001). Adjuvant mitotane therapy (n = 11) did not influence survival after total resection. Sixty-two patients were given mitotane treatment at some time during their illness, only 30 of whom reached high maintenance serum levels. Mitotane treatment with high serum levels had an independently favourable influence on patient survival, using univariate (P<0.01) and multivariate analysis (P = 0.01). Mitotane treatment resulting in low serum levels was tantamount to not giving mitotane at all. We conclude that mitotane treatment in adrenocortical carcinoma is effective only when high serum levels can be achieved.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients

Haak

Hermans²,

Cj³

et al. 1994

Br J Cancer

306

229

View full text Add to dashboard Cite

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Nomograms to Predict Recurrence-Free and Overall Survival After Curative Resection of Adrenocortical Carcinoma

et al. 2016

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IMPORTANCE Adrenocortical carcinoma (ACC) is a rare but aggressive endocrine tumor, and the prognostic factors associated with long-term outcomes after surgical resection remain poorly defined. OBJECTIVES To define clinicopathological variables associated with recurrence-free survival (RFS) and overall survival (OS) after curative surgical resection of ACC and to propose nomograms for individual risk prediction. DESIGN, SETTING, AND PARTICIPANTS Nomograms to predict RFS and OS after surgical resection of ACC were proposed using a multi-institutional cohort of patients who underwent curative-intent surgery for ACC at 13 major institutions in the United States between March 17, 1994, and December 22, 2014. The dates of our study analysis were April 15, 2015, to May 12, 2015. MAIN OUTCOMES AND MEASURES The discriminative ability and calibration of the nomograms to predict RFS and OS were tested using C statistics, calibration plots, and Kaplan-Meier curves. RESULTS In total, 148 patients who underwent surgery for ACC were included in the study. The median patient age was 53 years, and 65.5% (97 of 148) of the patients were female. One-third of the patients (35.1% [52 of 148]) had a functional tumor, and the median tumor size was 11.2 cm. Most patients (77.7% [115 of 148]) underwent R0 resection, and 8.8% (13 of 148) of the patients had N1 disease. Using backward stepwise selection of clinically important variables with the Akaike information criterion, the following variables were incorporated in the prediction of RFS: tumor size of at least 12 cm (hazard ratio [HR], 3.00; 95% CI, 1.63–5.70; P < .001), positive nodal status (HR, 4.78; 95% CI, 1.47–15.50; P = .01), stage III/IV (HR, 1.80; 95% CI, 0.95–3.39; P = .07), cortisol-secreting tumor (HR, 2.38; 95% CI, 1.27–4.48; P = .01), and capsular invasion (HR, 1.96; 95% CI, 1.02–3.74; P = .04). Factors selected as predicting OS were tumor size of at least 12 cm (HR, 1.78; 95% CI, 1.00–3.17; P = .05), positive nodal status (HR, 5.89; 95% CI, 2.05–16.87; P = .001), and R1 margin (HR, 2.83; 95% CI, 1.51–5.30; P = .001). The discriminative ability and calibration of the nomograms revealed good predictive ability as indicated by the C statistics (0.74 for RFS and 0.70 for OS). CONCLUSIONS AND RELEVANCE Independent predictors of survival and recurrence risk after curative-intent surgery for ACC were selected to create nomograms predicting RFS and OS. The nomograms were able to stratify patients into prognostic groups and performed well on internal validation.

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