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PSUN22 Outcomes of Adrenalectomy for Adrenocortical Carcinoma at a Single Institution
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare malignancy with a poor overall prognosis. Complete surgical resection is the mainstay of therapy. METHODS: We performed a retrospective review of adult patients at a single institution undergoing index adrenalectomy for initial diagnosis of adreno...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9624616/ http://dx.doi.org/10.1210/jendso/bvac150.256 |
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author | Gurney, Antonia Kotwal, Anupam Patel, Anery Shank, Jessica Yuil-Valdes, Ana Pachigolla, Srujana Goldner, Whitney Fingeret, Abbey |
author_facet | Gurney, Antonia Kotwal, Anupam Patel, Anery Shank, Jessica Yuil-Valdes, Ana Pachigolla, Srujana Goldner, Whitney Fingeret, Abbey |
author_sort | Gurney, Antonia |
collection | PubMed |
description | BACKGROUND: Adrenocortical carcinoma (ACC) is a rare malignancy with a poor overall prognosis. Complete surgical resection is the mainstay of therapy. METHODS: We performed a retrospective review of adult patients at a single institution undergoing index adrenalectomy for initial diagnosis of adrenocortical carcinoma from 2012 through 2021. Clinical and demographic variables were assessed. RESULTS: Fifteen patients were identified who underwent adrenalectomy for ACC during the study period with a mean age of 49.2 years (SD 17.8) with 6 (40%) male, 13 (87%) white, mean body mass index 29.5 kg/m2 (SD 7.5). On preoperative cross-sectional imaging nine (60%) were left sided tumors and the largest dimension was a mean of 11.1cm (SD 4.5), with pre-contrast density of 27.8 Hounsfield units (SD 9.6), five patients (36%) had evidence of local invasion and four patients (29%) had evidence of metastatic disease on imaging. Ten patients (67%) had biochemical evidence of hormone excess and eight had secretion of more than one cortical hormone, with overall ten (67%) glucocorticoid secretion, six (40%) androgen secretion, two (13%) mineralocorticoid secretion. Four patients (27%) had minimally invasive laparoscopic or robotic adrenalectomy. Three patients (20%) had a surgical complication including ileus, pancreatic leak and pleural effusion requiring intervention. Complications were not associated with hormone excess (p = 0.50). On final pathology, one patient (7%) was staged T0 who later presented with metastatic disease 18 months postoperatively, six (43%) were T2, 4 (29%) T3, and 3 (21%) T4. No patients had locoregional lymph node metastases. Ten patients (67%) had R0 resection with negative margins, 4 (27%) had microscopic positive margins, and 1 had grossly positive margins. Seven patients had Ki-67 assessed with a mean of 29% (SD 20.6). Ten patients (71%) received adjuvant mitotane, eight (53%) systemic chemotherapy, and 4 (27%) adjuvant radiation. Within the study period, nine patients (60%) had a recurrence and six patients died (40%) with a median survival of 24 months. Positive margin status was associated with mortality with mortality of one (10%) of patients with negative margins and 5 (100%) of those with positive margins (p = 0.002). Of the four patients who presented with initial evidence of metastatic disease on imaging, two died during the study period and the other two remain alive on therapy. Adjuvant treatment with mitotane, systemic chemotherapy, or radiation were not associated with survival. CONCLUSIONS: In this cohort, complete surgical resection with negative margins was associated with improved survival compared with patients with microscopic or grossly positive margins. The overall median survival was 24 months. Differences in outcome by adjuvant therapy are limited by the sample size. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m. |
format | Online Article Text |
id | pubmed-9624616 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-96246162022-11-14 PSUN22 Outcomes of Adrenalectomy for Adrenocortical Carcinoma at a Single Institution Gurney, Antonia Kotwal, Anupam Patel, Anery Shank, Jessica Yuil-Valdes, Ana Pachigolla, Srujana Goldner, Whitney Fingeret, Abbey J Endocr Soc Adrenal BACKGROUND: Adrenocortical carcinoma (ACC) is a rare malignancy with a poor overall prognosis. Complete surgical resection is the mainstay of therapy. METHODS: We performed a retrospective review of adult patients at a single institution undergoing index adrenalectomy for initial diagnosis of adrenocortical carcinoma from 2012 through 2021. Clinical and demographic variables were assessed. RESULTS: Fifteen patients were identified who underwent adrenalectomy for ACC during the study period with a mean age of 49.2 years (SD 17.8) with 6 (40%) male, 13 (87%) white, mean body mass index 29.5 kg/m2 (SD 7.5). On preoperative cross-sectional imaging nine (60%) were left sided tumors and the largest dimension was a mean of 11.1cm (SD 4.5), with pre-contrast density of 27.8 Hounsfield units (SD 9.6), five patients (36%) had evidence of local invasion and four patients (29%) had evidence of metastatic disease on imaging. Ten patients (67%) had biochemical evidence of hormone excess and eight had secretion of more than one cortical hormone, with overall ten (67%) glucocorticoid secretion, six (40%) androgen secretion, two (13%) mineralocorticoid secretion. Four patients (27%) had minimally invasive laparoscopic or robotic adrenalectomy. Three patients (20%) had a surgical complication including ileus, pancreatic leak and pleural effusion requiring intervention. Complications were not associated with hormone excess (p = 0.50). On final pathology, one patient (7%) was staged T0 who later presented with metastatic disease 18 months postoperatively, six (43%) were T2, 4 (29%) T3, and 3 (21%) T4. No patients had locoregional lymph node metastases. Ten patients (67%) had R0 resection with negative margins, 4 (27%) had microscopic positive margins, and 1 had grossly positive margins. Seven patients had Ki-67 assessed with a mean of 29% (SD 20.6). Ten patients (71%) received adjuvant mitotane, eight (53%) systemic chemotherapy, and 4 (27%) adjuvant radiation. Within the study period, nine patients (60%) had a recurrence and six patients died (40%) with a median survival of 24 months. Positive margin status was associated with mortality with mortality of one (10%) of patients with negative margins and 5 (100%) of those with positive margins (p = 0.002). Of the four patients who presented with initial evidence of metastatic disease on imaging, two died during the study period and the other two remain alive on therapy. Adjuvant treatment with mitotane, systemic chemotherapy, or radiation were not associated with survival. CONCLUSIONS: In this cohort, complete surgical resection with negative margins was associated with improved survival compared with patients with microscopic or grossly positive margins. The overall median survival was 24 months. Differences in outcome by adjuvant therapy are limited by the sample size. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m. Oxford University Press 2022-11-01 /pmc/articles/PMC9624616/ http://dx.doi.org/10.1210/jendso/bvac150.256 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Adrenal Gurney, Antonia Kotwal, Anupam Patel, Anery Shank, Jessica Yuil-Valdes, Ana Pachigolla, Srujana Goldner, Whitney Fingeret, Abbey PSUN22 Outcomes of Adrenalectomy for Adrenocortical Carcinoma at a Single Institution |
title | PSUN22 Outcomes of Adrenalectomy for Adrenocortical Carcinoma at a Single Institution |
title_full | PSUN22 Outcomes of Adrenalectomy for Adrenocortical Carcinoma at a Single Institution |
title_fullStr | PSUN22 Outcomes of Adrenalectomy for Adrenocortical Carcinoma at a Single Institution |
title_full_unstemmed | PSUN22 Outcomes of Adrenalectomy for Adrenocortical Carcinoma at a Single Institution |
title_short | PSUN22 Outcomes of Adrenalectomy for Adrenocortical Carcinoma at a Single Institution |
title_sort | psun22 outcomes of adrenalectomy for adrenocortical carcinoma at a single institution |
topic | Adrenal |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9624616/ http://dx.doi.org/10.1210/jendso/bvac150.256 |
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