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Resection of Adrenocortical Carcinoma Liver Metastasis: Is it Justified?

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

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.

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Acknowledgment

The authors thank Igor Dolgalev and Adriana Heguy from the Geoffrey Beene Translational Oncology Core at Memorial Sloan Kettering Cancer Center for their help in sequencing, and all the surgical and pathology department staff for their precious collaboration.

Disclosures

Sébastien Gaujoux was recipient of a grant from the European Society of Surgical Oncology (ESSO), and the Association Française de Chirurgie Hépato-Biliaire et de Transplantation Hépatique (ACHBT).

Conflict of interest

There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Sébastien Gaujoux MD, Peter J. Allen MD, Michael D’Angelica MD, Ronald Dematteo MD, Yuman Fong MD, Leslie Blumgart MD & William R. Jarnagin MD

  2. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Hikmat Al-Ahmadie MD & Jinru Shia MD

  3. Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Mithat Gonen PhD

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  1. Sébastien Gaujoux MD
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Correspondence to William R. Jarnagin MD.

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Gaujoux, S., Al-Ahmadie, H., Allen, P.J. et al. Resection of Adrenocortical Carcinoma Liver Metastasis: Is it Justified?. Ann Surg Oncol 19, 2643–2651 (2012). https://doi.org/10.1245/s10434-012-2358-7

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  • DOI: https://doi.org/10.1245/s10434-012-2358-7

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