Endocrine Abstracts

Background

The management of post-operative recurrences of ACC remains controversial, although the current guidelines recommend a surgical approach whenever feasible with radical intent.

Aim

The aim of our study was to evaluate retrospectively the management of recurrences in patients with ACC. We collected data of 106 patients with ACC followed at the San Luigi Hospital for the management of recurrence. Median follow up was 34 months.

Outcome

Baseline characteristics of our patients were: 59.4% women, median age 46 yrs, 31.4% ACC were incidentally discovered, 52.4% patients reported symptoms related to hormone excess (72.7% cortisol) and 7.6% to tumor mass, 71.7% ACC were stage I-II ENSAT, 73.8% underwent open surgery, and all were macroscopically resected (R0 or Rx surgery). Median Weiss Score was 7, median ki67 20%, and 59.4% of patients underwent adjuvant mitotane treatment following surgery. Median RFS was 12 months (IQR: 6–23), and median OS was 64 months (IQR 34–162). ACC recurrences occurred as a unique lesion (group A) in 35.8%, multiple lesions in a single organ (group B) in 20.8%, and affecting multiple organs (group C) in 43.4%. Baseline characteristics of patients stratified by the type of recurrence did not differ between them. Local treatment (surgery, radiotherapy or RFA) was used in 100% of patients of the group A, 66.7% in group B, and 26% in group C. After treatment of recurrence, 60% of patients were free of disease. Stratifying patients by type of recurrences, we found a significantly better OS for group A (P < 0.001). Stratifying patients by treatment of recurrence, we found a significant better OS for patients who underwent local treatment (P < 0.001). This finding may be linked to the better outcome of local recurrences. None of the variables considered (sex, age, symptomatology, ACC stage, type of surgery, Weiss Score, ki67) was a factor predicting the type of recurrence in multivariate analysis.

Conclusion

We managed ACC recurrences mainly with a local approach, not only when recurrences occurred as a unique lesion, and we were able to attain a disease-free status in 60% of patients. The chance of future survival was better when ACC recurred as a unique lesion allowing a local treatment.