Abstract
Background: One of the key issues in the treatment of adrenocortical carcinoma is the efficacy of repeat resection of local recurrence and metastatic disease in affected patients. Options in the treatment of locally recurrent or metastatic disease are limited because chemotherapy and radiotherapy generally do not provide any significant prolongation in survival in treated patients.
Methods: A series of 113 patients who presented to Memorial Sloan-Kettering Cancer Center for treatment of adrenocortical carcinoma are presented.
Results: The median overall survival for all 113 patients was 38 months (5-year survival, 37%). Patients presenting with early stage I or II disease (n = 57) had a median survival of 101 months (5-year survival, 60%), whereas those with late stage III or IV disease (n = 56) had a median survival of 15 months (5-year survival, 10%). Patients who had complete primary resection (n = 68) had a median survival of 74 months (5-year survival, 55%), whereas those with incomplete primary resection (n = 45) had a median survival of 12 months (5-year survival, 5%). Resection of locally recurrent or distant metastatic disease was performed in 47 of these patients. Patients who had a complete second resection had a median survival of 74 months (5-year survival, 57%), whereas those with incomplete second resection had a median survival of 16 months (5-year survival, 0%).
Conclusions: Improved survival is seen in patients who present with early stage and have complete primary resection. Patients who undergo complete repeat resection of local recurrence or distant metastasis also have improved survival. Complete repeat resection was more readily accomplished in discrete distant metastatic lesions compared with bulky local recurrences.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Brennan MF. Adrenocortical carcinoma. CA Cancer J Clin 1987;37:348–365.
MacFarlane DA. Cancer of the adrenal cortex: the natural history, prognosis and treatment in a study of fifty-five cases. Ann R Coll Surg Engl 1958;23:155–186.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.
Norton JA. Adrenal tumors. In: DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: principles and practice of oncology. 5th edn. Philadelphia: Lippincott-Raven, 1997:1659–1677.
Cohn K, Gottesman L, Brennan MF. Adrenocortical carcinoma. Surgery 1986;100:1170–1177.
Soreide JA, Brabrand K, Thoresen SO. Adrenal cortical carcinoma in Norway, 1970–1984. World J Surg 1992;16:663–668.
Wooten MD, King DK. Adrenal cortical carcinoma. Cancer 1993;72:3145–355.
Plager JE. Carcinoma of the adrenal cortex: clinical description, diagnosis, and treatment. Int Adv Surg Oncol 1984;7:329–353.
Hamwi GJ, Serbin RA, Kruger FA. Does adrenocortical hyperplasia result in adrenocortical carcinoma? N Engl J Med 1957;257:1153–1157.
Yano T, Linehan M, Anglard P, et al. Genetic changes in human adrenocortical carcinoma. J Natl Cancer Inst 1989;81:518–523.
Henry I, Grandjovans S, Couillin P, et al. Tumor-specific loss of 11p15.5 alleles in del11p13 Wilms tumor and in familial adrenocortical carcinoma. Proc Natl Acad Sci USA 1989;86:3247–3251.
McNicol AM, Nolan CE, Struthers AJ, Farauharson MA, Hermans J, Haak HR. Expression of p53 in adrenocortical tumours: clinicopathological correlations. J Pathol 1997;181:146–152.
Ohgaki H, Kleihues P, Heitz PU. p53 mutations in sporadic adrenocortical tumors. Int J Cancer 1993;54:408–410.
Reincke M, Karl M, Travis WH, et al. p53 mutations in human adrenocortical neoplasms: immunohistochemical and molecular studies. J Clin Endocrinol Metab 1994;78:790–794.
Pommier RF, Brennan MF. An eleven-year experience with adrenocortical carcinoma. Surgery 1992;112:963–971.
Icard P, Chapuis Y, Adnreassian B, Bernard A, Proye C. Adrenocortical carcinoma in surgically treated patients: a retrospective study on 156 cases by the French Association of Endocrine Surgery. Surgery 1992;112:972–980.
Zografos GC, Driscoll DL, Karakousis CP, Huben RP. Adrenal adenocarcinoma: a review of 53 cases. J Surg Onc 1994;55:160–164.
Haak HR, Hermans J, van de Velde CJ, et al. Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients. Br J Cancer 1994;69:947–951.
Crucitti F, Bellantone R, Ferrante A, Boscherini M, Crucitti P, The ACC Italian Registry Study Group. The Italian registry for adrenal cortical carcinoma: analysis of a multiinstitutional series of 129 patients. Surgery 1996;119:161–170.
Harrison LE, Gaudin P, Brennan MF. Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection. Ann Surg Oncol 1999; in press.
Venkatesh S, Hickey RC, Sellin RV, Fernandez JF, Samaan NA. Adrenal cortical carcinoma. Cancer 1989;64:765–769.
Luton J, Cerdas S, Line B, et al. Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med 1990;322:1195–1201.
Pommier RF, Brennan MF. Management of adrenal neoplasms. Curr Probl Surg 1991;28:657–739.
Percarpio B, Knowlton AH. Radiation therapy of adrenal cortical carcinoma. Acta Rad Ther Phys Biol 1976;15:288–292.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schulick, R.D., Brennan, M.F. Long-Term Survival After Complete Resection and Repeat Resection in Patients With Adrenocortical Carcinoma. Ann Surg Oncol 6, 719–726 (1999). https://doi.org/10.1007/s10434-999-0719-7
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10434-999-0719-7