The Overall Survival and Progression-Free Survival in Patients with Advanced Adrenocortical Cancer Is Increased after the Multidisciplinary Team Evaluation

Abstract

We aimed to evaluate the role of adrenal multidisciplinary team evaluation (MTE) in affecting the overall survival (OS) and progression-free survival (PFS) in patients with adrenocortical carcinoma (ACC). We included in a retrospective monocentric study 47 patients with ACC. We divided our cohort into group 1 (without adrenal-MTE discussion, ACC diagnosis from 2004 to 2012, n = 14) and group 2 (diagnosis and beginning of treatments after 2013, all discussed in the adrenal MTE, n = 33). OS was defined by the survival between the first and the last visit, while PFS as the time from the first visit to the progression of the disease. Kaplan–Meier curves were used to compare OS and PFS between Group 1 and Group 2. Group 1stages III–IV (n = 10) presented a shorter median OS than Group 2stages III–IV (25 patients, 4 vs. 31 months, p = 0.023). Likewise, the median PFS was lower in Group 1 as compared to Group 2 (2.9 vs. 17.2 months, p < 0.001). The gain in PFS (6 months) was also confirmed in stage III-IV patients (2.9 vs. 8.7 months, respectively, for Group 1 and Group 2, p = 0.02). Group 1 presented a median PFS of 4 months, while the median PFS of Group 2 was 14.7 months (p = 0.128). In conclusion, we found a significant gain in terms of survival in patients after the MTE discussion in 2013. Therefore, ACC patients should be referred to a tertiary center, ideally from the time of diagnosis, to promptly apply all available treatments, according to the single patient’s clinical history and based on multidisciplinary management.

Prognostic predictors of adrenocortical carcinoma: A single-center thirty-year experience

“…Care by multidisciplinary team evaluation was adopted in our cohort. Multidisciplinary care has been shown to improve overall and progression-free survival in patients with stage III-IV ACC (22). Similar survival benefits were also demonstrated in tumor stage I-III in a dutch study which revealed surgery performed outside the hospitals integrating care from multiple expertise was associated with increased risks of death (HR 1.96 [95% CI 1.01-3.81], p=0.047) (20).…”

Surgery for advanced adrenal malignant disease: recommendations based on European Society of Endocrine Surgeons consensus meeting

“…A study 80 of the impact of introducing a MDT discussion for all patients in a single centre compared 14 patients treated before the establishment of a formal adrenal MDT with 33 patients discussed by the MDT. Among patients with stage III–IV disease, there was longer median overall survival (31 versus 4 months) and longer progression-free survival (27 versus 3 months) for those discussed by the MDT, demonstrating significant gains in terms of survival.…”

Advanced Adrenocortical Carcinoma: From Symptoms Control to Palliative Care

“…Very advanced and complex ACC patients should be referred to tertiary centers early. We recently reported that early multidisciplinary evaluations can increase overall survival in patients with advanced ACC [ 6 ]. Nonetheless, curative treatments are the first part of the patient’s life: we only systematically included a simultaneous care approach and palliative care team in the multidisciplinary evaluation of ACC in recent months.…”

“…Common clinical features of ACC include steroid secretion and mass-related symptoms, often combined. The first characterizes the endocrine aspects of patients: cortisol or androgen excess varies from mild to overt secretion, including severe Cushing’s syndrome and female virilization [ 5 , 6 ].…”

“…A multidisciplinary team, with the primary focus on life-prolonging management, is the standard of care for patients with ACC: it includes periodical meetings involving, at the least, endocrinologists, medical and radiation oncologists, surgeons, pathologists, radiologists and genetic counsellors [ 3 , 5 ]. Several systemic antineoplastic regimens, extended resection and local treatments may be used in patients with advanced ACC, ultimately impairing the wellbeing and the quality-of-life (QoL) of patients with cancer and their families–caregivers [ 6 , 7 , 8 ].…”