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Annals of Surgical Oncology

, Volume 23, Issue 1, pp 134–141 | Cite as

Adrenocortical Carcinoma: Impact of Surgical Margin Status on Long-Term Outcomes

  • Georgios Antonios Margonis
  • Yuhree Kim
  • Jason D. Prescott
  • Thuy B. Tran
  • Lauren M. Postlewait
  • Shishir K. Maithel
  • Tracy S. Wang
  • Douglas B. Evans
  • Ioannis Hatzaras
  • Rivfka Shenoy
  • John E. Phay
  • Kara Keplinger
  • Ryan C. Fields
  • Linda X. Jin
  • Sharon M. Weber
  • Ahmed Salem
  • Jason K. Sicklick
  • Shady Gad
  • Adam C. Yopp
  • John C. Mansour
  • Quan-Yang Duh
  • Natalie Seiser
  • Carmen C. Solorzano
  • Colleen M. Kiernan
  • Konstantinos I. Votanopoulos
  • Edward A. Levine
  • George A. Poultsides
  • Timothy M. Pawlik
Endocrine Tumors

Abstract

Background

The influence of surgical margin status on long-term outcomes of patients undergoing adrenal resection for ACC remains not well defined. We studied the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ACC.

Methods

A total of 165 patients who underwent adrenal resection for ACC and met inclusion criteria were identified form a multi-institutional database. Clinicopathological data, pathologic margin status, and long-term outcomes were assessed. Patients were stratified into two groups based on margin status: R0 (margin >1 mm) versus R1.

Results

R0 resection was achieved in 126 patients (76.4 %), whereas 39 patients (23.6 %) had an R1 resection. Median and 5-year OS for patients undergoing R0 resection were 96.3 months and 64.8 % versus 25.1 months and 33.8 % for patients undergoing an R1 resection (both p < 0.001). On multivariable analysis, surgical margin status was an independent predictor of worse OS (hazard ratio [HR] 2.22, 95 % confidence interval [CI] 1.03–4.77; p = 0.04). The incidence of recurrence also differed between the two groups; 5-year RFS was 30.3 % among patients with an R0 resection versus 13.8 % among patients who had an R1 resection (p = 0.03). Lymph node metastasis (N1) was an independent predictor of RFS (HR 2.70, 95 % CI 1.04–6.99; p = 0.04).

Conclusions

A positive margin after ACC resection was associated with worse long-term survival. Patient selection and an emphasis on surgical technique to achieve R0 margins are pivotal to optimizing the best chance for long-term outcome among patients with ACC.

Keywords

Overall Survival Lynch Syndrome Margin Status Congenital Adrenal Hyperplasia Adrenocortical Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

None.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Georgios Antonios Margonis
    • 1
  • Yuhree Kim
    • 1
  • Jason D. Prescott
    • 1
  • Thuy B. Tran
    • 2
  • Lauren M. Postlewait
    • 3
  • Shishir K. Maithel
    • 3
  • Tracy S. Wang
    • 4
  • Douglas B. Evans
    • 4
  • Ioannis Hatzaras
    • 5
  • Rivfka Shenoy
    • 5
  • John E. Phay
    • 6
  • Kara Keplinger
    • 6
  • Ryan C. Fields
    • 7
  • Linda X. Jin
    • 7
  • Sharon M. Weber
    • 8
  • Ahmed Salem
    • 8
  • Jason K. Sicklick
    • 9
  • Shady Gad
    • 9
  • Adam C. Yopp
    • 10
  • John C. Mansour
    • 10
  • Quan-Yang Duh
    • 11
  • Natalie Seiser
    • 11
  • Carmen C. Solorzano
    • 12
  • Colleen M. Kiernan
    • 12
  • Konstantinos I. Votanopoulos
    • 13
  • Edward A. Levine
    • 13
  • George A. Poultsides
    • 2
  • Timothy M. Pawlik
    • 1
  1. 1.Department of SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of SurgeryStanford University School of MedicineStanfordUSA
  3. 3.Department of SurgeryEmory UniversityAtlantaUSA
  4. 4.Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  5. 5.Department of SurgeryNew York University School of MedicineNew YorkUSA
  6. 6.Department of SurgeryThe Ohio State UniversityColumbusUSA
  7. 7.Department of SurgeryWashington University School of MedicineSt. LouisUSA
  8. 8.Department of General SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  9. 9.Department of SurgeryUniversity of California San DiegoSan DiegoUSA
  10. 10.Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  11. 11.Department of SurgeryUniversity of California San FranciscoSan FranciscoUSA
  12. 12.Department of SurgeryVanderbilt UniversityNashvilleUSA
  13. 13.Department of SurgeryWake Forest School of MedicineWinston-SalemUSA

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