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Surgical Resection of Synchronously Metastatic Adrenocortical Cancer

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Metastatic adrenocortical carcinoma (ACC) is rapidly fatal, with few options for treatment. Patients with metachronous recurrence may benefit from surgical resection. The survival benefit in patients with hematogenous metastasis at initial presentation is unknown.

Methods

A review of all patients undergoing surgery (European Network for the Study of Adrenal Tumors) stage IV ACC between January 2000 and December 2012 from two referral centers was performed. Kaplan–Meier estimates were analyzed for disease-free and overall survival (OS).

Results

We identified 27 patients undergoing surgery for stage IV ACC. Metastases were present in the lung (19), liver (11), and brain (1). A complete resection (R0) was achieved in 11 patients. The median OS was improved in patients undergoing R0 versus R2 resection (860 vs. 390 days; p = 0.02). The 1- and 2-year OS was also improved in patients undergoing R0 versus R2 resection (69.9 %, 46.9 % vs. 53.0 %, 22.1 %; p = 0.02). Patients undergoing neoadjuvant therapy (eight patients) had a trend towards improved survival at 1, 2, and 5 years versus no neoadjuvant therapy (18 patients) [83.3 %, 62.5 %, 41.7 % vs. 56.8 %, 26.6 %, 8.9 %; p = 0.1]. Adjuvant therapy was associated with improved recurrence-free survival at 6 months and 1 year (67 %, 33 % vs. 40 %, 20 %; p = 0.04) but not improved OS (p = 0.63). Sex (p = 0.13), age (p = 0.95), and location of metastasis (lung, p = 0.51; liver, p = 0.67) did not correlate with OS after operative intervention. Symptoms of hormonal excess improved in 86 % of patients.

Conclusion

Operative intervention, especially when an R0 resection can be achieved, following systemic therapy may improve outcomes, including OS, in select patients with stage IV ACC. Response to neoadjuvant chemotherapy may be of use in defining which patients may benefit from surgical intervention. Adjuvant therapy was associated with decreased recurrence but did not improve OS.

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Disclosure

Benzon M. Dy has nothing to disclose.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Benzon M. Dy MD, Veljko Strajina MD, Melanie L. Richards MD, David R. Farley MD, Clive S. Grant MD, Florencia G. Que MD, David M. Nagorney MD & Geoffrey B. Thompson MD

  2. Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Ashley K. Cayo MD, Elizabeth G. Grubbs MD, Nancy D. Perrier MD & Jeffrey E. Lee MD

  3. Department of Statistics, Mayo Clinic, Rochester, MN, USA

    William S. Harmsen MD

  4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Doug B. Evans MD

  5. Department of Oncology, Mayo Clinic, Rochester, MN, USA

    Keith C. Bible MD

  6. Department of Endocrinology, Mayo Clinic, Rochester, MN, USA

    William F. Young MD

Authors
  1. Benzon M. Dy MD
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  2. Veljko Strajina MD
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  3. Ashley K. Cayo MD
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  4. Melanie L. Richards MD
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  7. William S. Harmsen MD
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  8. Doug B. Evans MD
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  9. Elizabeth G. Grubbs MD
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  10. Keith C. Bible MD
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  11. William F. Young MD
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  12. Nancy D. Perrier MD
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  13. Florencia G. Que MD
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  14. David M. Nagorney MD
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  15. Jeffrey E. Lee MD
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  16. Geoffrey B. Thompson MD
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Corresponding author

Correspondence to Geoffrey B. Thompson MD.

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Dy, B.M., Strajina, V., Cayo, A.K. et al. Surgical Resection of Synchronously Metastatic Adrenocortical Cancer. Ann Surg Oncol 22, 146–151 (2015). https://doi.org/10.1245/s10434-014-3944-7

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  • DOI: https://doi.org/10.1245/s10434-014-3944-7

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