ECE2009 Poster Presentations Endocrine tumours and neoplasia (53 abstracts)
Impact of surgery on clinical outcome in patients with recurrence of adrenocortical carcinoma
Ilknur Erdogan 1 , Stefanie Hahner 1 , Sarah Johanssen 1 , Wiebke Fenske 1 , Marcus Quinkler 2 , Holger S Willenberg 3 , Felix Beuschlein 4 , David Brix 5 , Bruno Allolio 1 & Martin Fassnacht 1
1Department of Medicine, University Hospital, Würzburg, Germany; 2Department of Medicine, Charite University, Campus Mitte, Berlin, Germany; 3Department of Endocrinology, Diabetes, Rheumatology, University Hospital, Düsseldorf, Germany; 4Department of Medicine, Innenstadtklinikum, University Hospital, Munich, Germany; 5Department of Urology, University Hospital, Würzburg, Germany.
Introduction: The role of surgery for recurrent ACC is not well defined. Therefore, we used the German ACC Registry to evaluate treatment modalities after first recurrence in patients amenable to surgery.
Methods: Patients with recurrence after radical resection and follow-up data were included. Patients with extensive metastasized disease (>2 tumoral organs, peritoneal carcinomatosis) were excluded. Progression-free and overall survival (PFS/OS) were analysed using the Kaplan–Maier and cox regression methods.
Results: In 351/506 patients registered with the German ACC Registry radical resection was performed. Of 223 of these patients experienced recurrence during follow-up and 76 fulfilled all inclusion and exclusion criteria. Patients presented with local recurrence (n=33), liver, lung, or lymph node metastases (n=15, 11, 2 respectively). In 15 patients two organs were affected. Median follow-up was 30 (6–250) months. Of 68 patients underwent second surgery (R0 n=29; R1/Rx n=32; R2 n=7). Patients voting against surgery were treated with mitotane (n=6) or mitotane plus cytotoxic drugs (n=2). Of 68 patients experienced progressive disease after a median of 7 (2–144) months. PFS after recurrence was prolonged in patients with time to first recurrence (TTFR) >12 months (14 vs 6 months; P<0.001), but PFS was not significantly associated with surgery, resection status, or number of lesions. In contrast, TTFR and surgery were associated with reduced risk for death after recurrence (HR 0.23 (95% CI 0.11–0.50) and HR 0.38 (0.16–0.94), respectively). However, in multivariate analysis only TTFR was of prognostic value (HR 0.25 (0.11–0.56) P=0.001). There was a clear trend favouring patients with R0 resection (HR 0.44 (0.14–1.37)), but not with R2 resection (HR 1.43 (0.42–4.88)).
Conclusion: In ACC, after first recurrence 90% of patients experience progression of disease independent of therapy. The best predictor for survival after recurrence is time to first recurrence. Our study suggests that surgery is of benefit only if complete resection is feasible.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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