ICEECE2012 Poster Presentations Endocrine tumours and neoplasia (112 abstracts)
The influence of surgery in the management of recurrent adrenocortical carcinoma.
T. Deutschbein 1 , I. Erdogan 1 , C. Jurowich 1 , M. Kroiss 1 , M. Quinkler 2 , P. Langer 3 , H. Willenberg 4 , F. Beuschlein 5 , C. Fottner 6 , S. Klose 7 , A. Heidemeier 1 , D. Brix 1 , W. Fenske 1 , S. Hahner 1 , J. Reibetanz 1 , B. Allolio 1 & M. Fassnacht 1
University of Wuerzburg, Wuerzburg, Germany.
Objective: The role of surgery for recurrent adrenocortical carcinomas (ACC) is not well defined. Therefore, we evaluated the outcome after surgery for tumor recurrence in patients from the German ACC Registry.
Methods: Only patients with first recurrence after initial R0 resection were investigated. Progression–free and overall survival (PFS, OS) after first recurrence were analyzed by Kaplan–Meier method. Cox proportional hazards regression models were used to identify prognostic factors.
Result: Of 154 patients with first recurrence, 101 underwent repeated surgery (R0 resection, n=78) and 99 received (additional) nonsurgical therapy. After a median interval of 6 (range 1–221) months, 144 patients (94%) experienced progressive disease. Multivariate analysis adjusted for age, sex, tumor burden, time to first recurrence (TTFR), resection status after surgery for recurrence and additional therapy indicated that only two factors were significantly associated with shorter PFS (hazard ratio for progression: TTFR >12 months 1.8 [95% CI 1.2–2.5] in comparison to TTFR ≤12 months; R2 resection 3.4 [1.5–8.0] and no surgery 3.4 [1.7–7.1] in comparison to R0 resection) and OS (hazard ratio for death: TTFR >12 months 3.0 [2.0–4.6] in comparison to TTFR ≤12 months; R2 resection 2.6 [1.0–6.7] and no surgery 4.2 [1.8–9.8] in comparison to R0 resection). Patients who had both TTFR >12 months and R0 resection of recurrent tumors (n=22) had the best prognosis (median PFS 24 months, median OS 58 months).
Conclusions: The best predictors of prolonged survival after first recurrence of ACC are TTFR >12 months and R0 resection. Patients with longer TTFR and tumors amenable to radical resection should therefore be operated, whereas patients with shorter TTFR or tumors not amenable to radical resection do most likely not benefit from incomplete surgery.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.
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