Endocrine Tumors

Annals of Surgical Oncology

, Volume 19, Issue 8, pp 2643-2651

Resection of Adrenocortical Carcinoma Liver Metastasis: Is it Justified?

  • Sébastien GaujouxAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Hikmat Al-AhmadieAffiliated withDepartment of Pathology, Memorial Sloan-Kettering Cancer Center
  • , Peter J. AllenAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Mithat GonenAffiliated withDepartment of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center
  • , Jinru ShiaAffiliated withDepartment of Pathology, Memorial Sloan-Kettering Cancer Center
  • , Michael D’AngelicaAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Ronald DematteoAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Yuman FongAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center
  • , Leslie BlumgartAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer Center

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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.