TY - JOUR
T1 - Cytoreductive Surgery of the Primary Tumor in Metastatic Adrenocortical Carcinoma
T2 - Impact on Patients' Survival
AU - Srougi, Victor
AU - Bancos, Irina
AU - Daher, Marilyne
AU - Lee, Jeffrey E.
AU - Graham, Paul H.
AU - Karam, Jose A.
AU - Henriquez, Andres
AU - McKenzie, Travis J.
AU - Sada, Alaa
AU - Bourdeau, Isabelle
AU - Poirier, Jonathan
AU - Vaidya, Anand
AU - Abbondanza, Tiffany
AU - Kiernan, Colleen M.
AU - Rao, Sarika N.
AU - Hamidi, Oksana
AU - Sachithanandan, Nirupa
AU - Hoff, Ana O.
AU - Chambo, Jose L.
AU - Almeida, Madson Q.
AU - Habra, Mouhammed Amir
AU - Fragoso, Maria C.B.V.
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Context: The role of cytoreduction of adrenocortical carcinoma (ACC) remains poorly understood. Objective: To analyze the impact of cytoreductive surgery of the primary tumor in patients with metastatic ACC. Design and Setting: We performed a multicentric, retrospective paired cohort study comparing the overall survival (OS) in patients with metastatic ACC who were treated either with cytoreductive surgery (CR group) or without cytoreductive surgery (no-CR group) of the primary tumor. Data were retrieved from 9 referral centers in the American-Australian-Asian Adrenal Alliance collaborative research group. Patients: Patients aged ≥18 years with metastatic ACC at initial presentation who were treated between January 1, 1995, and May 31, 2019. Intervention: Performance (or not) of cytoreductive surgery of the primary tumor. Main outcome and measures: A propensity score match was done using age and the number of organs with metastasis (≤2 or >2). The main outcome was OS, determined from the date of diagnosis until death or until last follow-up for living patients. Results: Of 339 patients pooled, 239 were paired and included: 128 in the CR group and 111 in the no-CR group. The mean follow-up was 67 months. Patients in the no-CR group had greater risk of death than did patients in the CR group (hazard ratio [HR] = 3.18; 95% CI, 2.34-4.32). Independent predictors of survival included age (HR = 1.02; 95% CI, 1.00-1.03), hormone excess (HR = 2.56; 95% CI, 1.66-3.92), and local metastasis therapy (HR = 0.41; 95% CI, 0.47-0.65). Conclusion: Cytoreductive surgery of the primary tumor in patients with metastatic ACC is associated with prolonged survival.
AB - Context: The role of cytoreduction of adrenocortical carcinoma (ACC) remains poorly understood. Objective: To analyze the impact of cytoreductive surgery of the primary tumor in patients with metastatic ACC. Design and Setting: We performed a multicentric, retrospective paired cohort study comparing the overall survival (OS) in patients with metastatic ACC who were treated either with cytoreductive surgery (CR group) or without cytoreductive surgery (no-CR group) of the primary tumor. Data were retrieved from 9 referral centers in the American-Australian-Asian Adrenal Alliance collaborative research group. Patients: Patients aged ≥18 years with metastatic ACC at initial presentation who were treated between January 1, 1995, and May 31, 2019. Intervention: Performance (or not) of cytoreductive surgery of the primary tumor. Main outcome and measures: A propensity score match was done using age and the number of organs with metastasis (≤2 or >2). The main outcome was OS, determined from the date of diagnosis until death or until last follow-up for living patients. Results: Of 339 patients pooled, 239 were paired and included: 128 in the CR group and 111 in the no-CR group. The mean follow-up was 67 months. Patients in the no-CR group had greater risk of death than did patients in the CR group (hazard ratio [HR] = 3.18; 95% CI, 2.34-4.32). Independent predictors of survival included age (HR = 1.02; 95% CI, 1.00-1.03), hormone excess (HR = 2.56; 95% CI, 1.66-3.92), and local metastasis therapy (HR = 0.41; 95% CI, 0.47-0.65). Conclusion: Cytoreductive surgery of the primary tumor in patients with metastatic ACC is associated with prolonged survival.
KW - adrenocortical carcinoma
KW - cytoreduction surgical procedures
KW - surgery
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85127835192&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127835192&partnerID=8YFLogxK
U2 - 10.1210/clinem/dgab865
DO - 10.1210/clinem/dgab865
M3 - Article
C2 - 34850915
AN - SCOPUS:85127835192
SN - 0021-972X
VL - 107
SP - 964
EP - 971
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 4
ER -