Annals of Surgical Oncology

, Volume 19, Issue 8, pp 2643–2651

Resection of Adrenocortical Carcinoma Liver Metastasis: Is it Justified?

  • Sébastien Gaujoux
  • Hikmat Al-Ahmadie
  • Peter J. Allen
  • Mithat Gonen
  • Jinru Shia
  • Michael D’Angelica
  • Ronald Dematteo
  • Yuman Fong
  • Leslie Blumgart
  • William R. Jarnagin
Endocrine Tumors

DOI: 10.1245/s10434-012-2358-7

Cite this article as:
Gaujoux, S., Al-Ahmadie, H., Allen, P.J. et al. Ann Surg Oncol (2012) 19: 2643. doi:10.1245/s10434-012-2358-7
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Abstract

Background

Adrenocortical carcinoma (ACC) liver metastases (LM) represent a therapeutic challenge, and it is unclear whether resection is justified. This study assesses long-term outcome and prognostic factors after liver resection for metastatic ACC.

Methods

Patients who underwent resection of ACC LM were identified from institutional databases. Recurrence, survival, and tumor characteristics, including β-catenin and TP53 status based on immunohistochemistry and sequencing, were reviewed. The prognostic value of variables was assessed with log-rank test for univariate analysis and Cox proportional hazard models for multivariate analysis.

Results

From 1978 to 2009, 28 patients (20 females; median age, 45 years), including 11 with synchronous metastasis and 3 with extrahepatic metastasis, underwent resection for ACC LM (major hepatectomy in 61%). Postoperative mortality was nil and morbidity 55%. On pathological examination, tumors were multiple in 68%, with a median size of 43 mm, and resections were R0, 1, and 2 in 59%, 33%, and 7%, respectively. All 28 patients developed recurrent disease, which was treated surgically in 11, including repeat hepatectomy in 4. Of the 15 patients with adequate tissue for analysis, β-catenin immunostaining was positive in 7, with 4 corresponding CTNNB1 mutations associated with decreased survival; p53 staining was positive in 5 (4 with corresponding TP53 mutations). The median disease-free and overall survival after hepatectomy was 7 and 31.5 months, respectively, with a 5-year survival of 39%. In multivariate analysis, nonfunctional tumor and surgical treatment of recurrence were independent predictors of good outcome.

Conclusions

In selected patients with ACC LM, resection is associated with long-term survival and is, therefore, justified but rarely curative.

Supplementary material

10434_2012_2358_MOESM1_ESM.doc (59 kb)
Supplementary material 1 (DOC 59 kb)

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Sébastien Gaujoux
    • 1
  • Hikmat Al-Ahmadie
    • 2
  • Peter J. Allen
    • 1
  • Mithat Gonen
    • 3
  • Jinru Shia
    • 2
  • Michael D’Angelica
    • 1
  • Ronald Dematteo
    • 1
  • Yuman Fong
    • 1
  • Leslie Blumgart
    • 1
  • William R. Jarnagin
    • 1
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Biostatistics and EpidemiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA