Curative Surgical Resection of Adrenocortical Carcinoma: Determining Long-term Outcome Based on Conditional Disease-free Probability

Yuhree Kim, Georgios A. Margonis, Jason D. Prescott, Thuy B. Tran, Lauren M. Postlewait, Shishir K. Maithel, Tracy S. Wang, Jason A. Glenn, 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. MansourQuan Yang Duh, Natalie Seiser, Carmen C. Solorzano, Colleen M. Kiernan, Konstantinos I. Votanopoulos, Edward A. Levine, George A. Poultsides, Timothy M. Pawlik

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

OBJECTIVE:: To evaluate conditional disease-free survival (CDFS) for patients who underwent curative intent surgery for adrenocortical carcinoma (ACC). BACKGROUND:: ACC is a rare but aggressive tumor. Survival estimates are usually reported as survival from the time of surgery. CDFS estimates may be more clinically relevant by accounting for the changing likelihood of disease-free survival (DFS) according to time elapsed after surgery. METHODS:: CDFS was assessed using a multi-institutional cohort of patients. Cox proportional hazards models were used to evaluate factors associated with DFS. Three-year CDFS (CDFS3) estimates at “x” year after surgery were calculated as follows: CDFS3?=?DFS(x+3)/DFS(x). RESULTS:: One hundred ninety-two patients were included in the study cohort; median patient age was 52 years. On presentation, 36% of patients had a functional tumor and median size was 11.5?cm. Most patients underwent R0 resection (75%) and 9% had N1 disease. Overall 1-, 3-, and 5-year DFS was 59%, 34%, and 22%, respectively. Using CDFS estimates, the probability of remaining disease free for an additional 3 years given that the patient had survived without disease at 1, 3, and 5 years, was 43%, 53%, and 70%, respectively. Patients with less favorable prognosis at baseline demonstrated the greatest increase in CDFS3 over time (eg, capsular invasion: 28%–88%, Δ60% vs no capsular invasion: 51%–87%, Δ36%). CONCLUSIONS:: DFS estimates for patients with ACC improved dramatically over time, in particular among patients with initial worse prognoses. CDFS estimates may provide more clinically relevant information about the changing likelihood of DFS over time.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Dec 29 2015

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Adrenocortical Carcinoma
Disease-Free Survival
Survival
Proportional Hazards Models

ASJC Scopus subject areas

  • Surgery

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Kim, Y., Margonis, G. A., Prescott, J. D., Tran, T. B., Postlewait, L. M., Maithel, S. K., ... Pawlik, T. M. (Accepted/In press). Curative Surgical Resection of Adrenocortical Carcinoma: Determining Long-term Outcome Based on Conditional Disease-free Probability. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001527

Curative Surgical Resection of Adrenocortical Carcinoma : Determining Long-term Outcome Based on Conditional Disease-free Probability. / Kim, Yuhree; Margonis, Georgios A.; Prescott, Jason D.; Tran, Thuy B.; Postlewait, Lauren M.; Maithel, Shishir K.; Wang, Tracy S.; Glenn, Jason A.; Hatzaras, Ioannis; Shenoy, Rivfka; Phay, John E.; Keplinger, Kara; Fields, Ryan C.; Jin, Linda X.; Weber, Sharon M.; Salem, Ahmed; Sicklick, Jason K.; Gad, Shady; Yopp, Adam C.; Mansour, John C.; Duh, Quan Yang; Seiser, Natalie; Solorzano, Carmen C.; Kiernan, Colleen M.; Votanopoulos, Konstantinos I.; Levine, Edward A.; Poultsides, George A.; Pawlik, Timothy M.

In: Annals of Surgery, 29.12.2015.

Research output: Contribution to journalArticle

Kim, Y, Margonis, GA, Prescott, JD, Tran, TB, Postlewait, LM, Maithel, SK, Wang, TS, Glenn, JA, Hatzaras, I, Shenoy, R, Phay, JE, Keplinger, K, Fields, RC, Jin, LX, Weber, SM, Salem, A, Sicklick, JK, Gad, S, Yopp, AC, Mansour, JC, Duh, QY, Seiser, N, Solorzano, CC, Kiernan, CM, Votanopoulos, KI, Levine, EA, Poultsides, GA & Pawlik, TM 2015, 'Curative Surgical Resection of Adrenocortical Carcinoma: Determining Long-term Outcome Based on Conditional Disease-free Probability', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001527
Kim, Yuhree ; Margonis, Georgios A. ; Prescott, Jason D. ; Tran, Thuy B. ; Postlewait, Lauren M. ; Maithel, Shishir K. ; Wang, Tracy S. ; Glenn, Jason A. ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Phay, John E. ; Keplinger, Kara ; Fields, Ryan C. ; Jin, Linda X. ; Weber, Sharon M. ; Salem, Ahmed ; Sicklick, Jason K. ; Gad, Shady ; Yopp, Adam C. ; Mansour, John C. ; Duh, Quan Yang ; Seiser, Natalie ; Solorzano, Carmen C. ; Kiernan, Colleen M. ; Votanopoulos, Konstantinos I. ; Levine, Edward A. ; Poultsides, George A. ; Pawlik, Timothy M. / Curative Surgical Resection of Adrenocortical Carcinoma : Determining Long-term Outcome Based on Conditional Disease-free Probability. In: Annals of Surgery. 2015.
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title = "Curative Surgical Resection of Adrenocortical Carcinoma: Determining Long-term Outcome Based on Conditional Disease-free Probability",
abstract = "OBJECTIVE:: To evaluate conditional disease-free survival (CDFS) for patients who underwent curative intent surgery for adrenocortical carcinoma (ACC). BACKGROUND:: ACC is a rare but aggressive tumor. Survival estimates are usually reported as survival from the time of surgery. CDFS estimates may be more clinically relevant by accounting for the changing likelihood of disease-free survival (DFS) according to time elapsed after surgery. METHODS:: CDFS was assessed using a multi-institutional cohort of patients. Cox proportional hazards models were used to evaluate factors associated with DFS. Three-year CDFS (CDFS3) estimates at “x” year after surgery were calculated as follows: CDFS3?=?DFS(x+3)/DFS(x). RESULTS:: One hundred ninety-two patients were included in the study cohort; median patient age was 52 years. On presentation, 36{\%} of patients had a functional tumor and median size was 11.5?cm. Most patients underwent R0 resection (75{\%}) and 9{\%} had N1 disease. Overall 1-, 3-, and 5-year DFS was 59{\%}, 34{\%}, and 22{\%}, respectively. Using CDFS estimates, the probability of remaining disease free for an additional 3 years given that the patient had survived without disease at 1, 3, and 5 years, was 43{\%}, 53{\%}, and 70{\%}, respectively. Patients with less favorable prognosis at baseline demonstrated the greatest increase in CDFS3 over time (eg, capsular invasion: 28{\%}–88{\%}, Δ60{\%} vs no capsular invasion: 51{\%}–87{\%}, Δ36{\%}). CONCLUSIONS:: DFS estimates for patients with ACC improved dramatically over time, in particular among patients with initial worse prognoses. CDFS estimates may provide more clinically relevant information about the changing likelihood of DFS over time.",
author = "Yuhree Kim and Margonis, {Georgios A.} and Prescott, {Jason D.} and Tran, {Thuy B.} and Postlewait, {Lauren M.} and Maithel, {Shishir K.} and Wang, {Tracy S.} and Glenn, {Jason A.} and Ioannis Hatzaras and Rivfka Shenoy and Phay, {John E.} and Kara Keplinger and Fields, {Ryan C.} and Jin, {Linda X.} and Weber, {Sharon M.} and Ahmed Salem and Sicklick, {Jason K.} and Shady Gad and Yopp, {Adam C.} and Mansour, {John C.} and Duh, {Quan Yang} and Natalie Seiser and Solorzano, {Carmen C.} and Kiernan, {Colleen M.} and Votanopoulos, {Konstantinos I.} and Levine, {Edward A.} and Poultsides, {George A.} and Pawlik, {Timothy M.}",
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T1 - Curative Surgical Resection of Adrenocortical Carcinoma

T2 - Determining Long-term Outcome Based on Conditional Disease-free Probability

AU - Kim, Yuhree

AU - Margonis, Georgios A.

AU - Prescott, Jason D.

AU - Tran, Thuy B.

AU - Postlewait, Lauren M.

AU - Maithel, Shishir K.

AU - Wang, Tracy S.

AU - Glenn, Jason A.

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Phay, John E.

AU - Keplinger, Kara

AU - Fields, Ryan C.

AU - Jin, Linda X.

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Sicklick, Jason K.

AU - Gad, Shady

AU - Yopp, Adam C.

AU - Mansour, John C.

AU - Duh, Quan Yang

AU - Seiser, Natalie

AU - Solorzano, Carmen C.

AU - Kiernan, Colleen M.

AU - Votanopoulos, Konstantinos I.

AU - Levine, Edward A.

AU - Poultsides, George A.

AU - Pawlik, Timothy M.

PY - 2015/12/29

Y1 - 2015/12/29

N2 - OBJECTIVE:: To evaluate conditional disease-free survival (CDFS) for patients who underwent curative intent surgery for adrenocortical carcinoma (ACC). BACKGROUND:: ACC is a rare but aggressive tumor. Survival estimates are usually reported as survival from the time of surgery. CDFS estimates may be more clinically relevant by accounting for the changing likelihood of disease-free survival (DFS) according to time elapsed after surgery. METHODS:: CDFS was assessed using a multi-institutional cohort of patients. Cox proportional hazards models were used to evaluate factors associated with DFS. Three-year CDFS (CDFS3) estimates at “x” year after surgery were calculated as follows: CDFS3?=?DFS(x+3)/DFS(x). RESULTS:: One hundred ninety-two patients were included in the study cohort; median patient age was 52 years. On presentation, 36% of patients had a functional tumor and median size was 11.5?cm. Most patients underwent R0 resection (75%) and 9% had N1 disease. Overall 1-, 3-, and 5-year DFS was 59%, 34%, and 22%, respectively. Using CDFS estimates, the probability of remaining disease free for an additional 3 years given that the patient had survived without disease at 1, 3, and 5 years, was 43%, 53%, and 70%, respectively. Patients with less favorable prognosis at baseline demonstrated the greatest increase in CDFS3 over time (eg, capsular invasion: 28%–88%, Δ60% vs no capsular invasion: 51%–87%, Δ36%). CONCLUSIONS:: DFS estimates for patients with ACC improved dramatically over time, in particular among patients with initial worse prognoses. CDFS estimates may provide more clinically relevant information about the changing likelihood of DFS over time.

AB - OBJECTIVE:: To evaluate conditional disease-free survival (CDFS) for patients who underwent curative intent surgery for adrenocortical carcinoma (ACC). BACKGROUND:: ACC is a rare but aggressive tumor. Survival estimates are usually reported as survival from the time of surgery. CDFS estimates may be more clinically relevant by accounting for the changing likelihood of disease-free survival (DFS) according to time elapsed after surgery. METHODS:: CDFS was assessed using a multi-institutional cohort of patients. Cox proportional hazards models were used to evaluate factors associated with DFS. Three-year CDFS (CDFS3) estimates at “x” year after surgery were calculated as follows: CDFS3?=?DFS(x+3)/DFS(x). RESULTS:: One hundred ninety-two patients were included in the study cohort; median patient age was 52 years. On presentation, 36% of patients had a functional tumor and median size was 11.5?cm. Most patients underwent R0 resection (75%) and 9% had N1 disease. Overall 1-, 3-, and 5-year DFS was 59%, 34%, and 22%, respectively. Using CDFS estimates, the probability of remaining disease free for an additional 3 years given that the patient had survived without disease at 1, 3, and 5 years, was 43%, 53%, and 70%, respectively. Patients with less favorable prognosis at baseline demonstrated the greatest increase in CDFS3 over time (eg, capsular invasion: 28%–88%, Δ60% vs no capsular invasion: 51%–87%, Δ36%). CONCLUSIONS:: DFS estimates for patients with ACC improved dramatically over time, in particular among patients with initial worse prognoses. CDFS estimates may provide more clinically relevant information about the changing likelihood of DFS over time.

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