Surgical Management of Advanced Adrenocortical Carcinoma: A 21-year Population-based Analysis

Abstract

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a dismal prognosis. When diagnosed in advanced stages of the disease, the outcomes of surgical resection are not well understood. The objective of this study is to determine the impact of surgery in patients with advanced ACC. Using the Surveillance, Epidemiology and End Results database, we identified patients diagnosed with Stage III and IVACC between 1988 and 2009. A total of 320 patients with Stage III and IV disease were included in our analysis. In patients treated with surgical resection, the Stage III 1- and 5-year survival rates were 77 and 40 per cent, respectively, whereas the Stage IV 1- and 5-year survival rates were 54 and 27.6 per cent, respectively. Patients treated without surgery had poor survival at 1 year for both Stage III (13%) and Stage IV (16%) ( P < 0.01 compared with the surgical groups). Lymph node dissection was performed in 26 per cent of the patients with advanced ACC and was associated with improved survival in univariate analysis of Stage IV patients. Overall, our results indicate that favorable survival outcomes can be achieved even in patients with Stage III and IV disease and surgery should be considered in patients with advanced ACC.

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors

“…Adverse effects from chemotherapy, however, are common and diverse (see Appendix 6). Sixteen studies focused on surgery in recurrent and advanced ACC; six publications reported on oligometastasectomy (lung and liver) (126,127,128,129,130,131), whereas ten publications assessed the effect of surgery in local recurrent and/or metastatic disease (61,66,78,132,133,134,135,136,137,138). In patients with metastasectomy, 5-year survival rates up to 40% were reported (126,127), although control groups were lacking (+OOO).…”

Critical analysis of lymph node examination in patients undergoing curative‐intent resection for adrenocortical carcinoma

“…5,[12][13][14][15] Among these studies, reported rates of lymphadenectomy range from only 6% to 33%. 3,5,[12][13][14][15][16][17] Moreover, examination of any lymph nodes has been alarmingly low, with reported rates less than 35%. 3,5,[12][13][14][15][16][17] Despite the low frequency of lymph node examination, nodal metastasis has been identified as an independent negative predictor of survival.…”

Neutrophil‐lymphocyte and platelet‐lymphocyte ratio as predictors of disease specific survival after resection of adrenocortical carcinoma

“…When discovered, surgery remains the only possible curative treatment for patients with ACC . Despite several studies suggesting an improved survival over the last 20 years, the prognosis of patients after surgical resection is not well defined with overall 5‐year survival ranging widely from 16% to 77% . Currently, the most commonly utilized scheme to predict prognosis for patients with ACC is the AJCC tumor, node, metastasis (TNM) staging system .…”

“…While several tumor specific morphologic factors have been associated with prognosis (e.g., tumor size), other prognostic factors are not well defined, largely because of the small sample size of most studies . Several studies have examined prognostic factors including patient‐ and tumor‐specific characteristics, but the impact of other constitutional factors such as the immune system have not been investigated among patients with ACC .…”