ECE2013 Oral Communications Adrenal (6 abstracts)
Prognostic factors of advanced unresectable by stage III and IV ENS@T adrenocortical carcinomas (ACC)
Rossella Libe 1 , Isabelle Borget 2 , Cristina Ronchi 3 , Massimo Terzolo 4 , Michaela Haaf 3 , Federica Laino 4 , Thomas Kherkhof 5 , Elisa Corsini 6 , Antoine Tabarin 7 , Olivier Chabre 8 , Christelle De la Fouchardière 9 , Patricia Niccoli 10 , Philippe Caron 11 , Massimo Mannelli 6 , Harm Haak 5 , Felix Beuchlein 12 , Jerome Bertherat 13 , Alfredo Berruti 14 , Martin Fassnacht 3 & Eric Baudin 2
1National Network COMETE, Paris, France; 2Institute Gustave Roussy, Villejuif, France; 3University of Wuerzburg, Wuerzburg, Germany; 4University of Orbassano, Orbassano, Italy; 5University of Einthoven, Einthoven, The Netherlands; 6University of Florence, Florence, Italy; 7CHU Bordeaux, Bordeau, France; 8CHU Grenoble, Grenoble, France; 9Centre Léon Berard, Lyon, France; 10CHU Marseille, Marseille, France; 11CHU Toulouse, Toulouse, France; 12University of Munich, Munich, Germany; 13Université Paris Descartes, Paris, France; 14University of Brescia, Brescia, Italy.
Introduction: The prognosis of stages III–IV ACC patients is dismal. The 5-year survival of stage IV ACC ranges between 0 and 13% and no prognostic study has focused on stage III, yet. Several reports suggest a greater heterogeneity of advanced ACC prognosis that initially thought.
Aim: The primary objective of our study was to analyse the prognostic factors of overall survival of the subgroup of advanced unresectable stage III–IV ACC patients collected in the ACC-ENS@T registry.
Methodology: The primary end-point was to determine the median overall survival (OS). Secondary objectives were: 1, 2, 5 year-OS, to refine the prognostic stratification, to analyse the role of early ACC management and delays in treatment. All relevant clinical parameters as well as therapeutic management were captured. Weiss score and ki67 index performed in a subgroup of patients (236 and 122, respectively) were analyzed in a second model.
Patients: Three hundred and thirty-four adult patients were enrolled (100 stage III and 234 stage IV ACC) treated between 2000 and 2009. Inclusion criteria were: age >18 years, unresctable ACC (R1, R2, Rx), clinical and follow-up data available.
Results: After a median follow-up of 60 months two hundred and fifty patients (74%) died. Median OS was 20 months. The 1-, 2- and 5-years survival rates were 67, 42 and 19%.
At multivariate analysis, age >50 years (HR=1.4, P=0.02), glucocorticoids secretion (HR=1.3, P=0.04), number of tumor organs >3 (HR=3.2, P<0.0001), adipose infiltration (HR=1.8, P=0.0009) and adrenalectomy (HR=0.4, P<0.0001) were significantly associated with the risk of death. When pathogical parameters were entered in the MV model, only Ki-67>20% HR=3.6, P=0.001) remained significant.
Conclusion: This large ENSAT prognostic study allows to propose a prognostic stratification of advanced ACC patients that will drive future therapeutic approaches. Surgery of adrenal primary is confirmed as a major therapeutic intervention. Ki 67 determination becomes mandatory.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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