Clinical Score Predicting Long-Term Survival after Repeat Resection for Recurrent Adrenocortical Carcinoma

Abstract

BACKGROUND Adrenocortical carcinoma (ACC) is an aggressive malignancy typically resistant to chemotherapy and radiation. Surgery, even in the setting of locally recurrent or metastatic disease, remains the only potentially curative option. However, the subset of patients who will benefit from repeat resection in this setting remains ill defined. The objective of this study was to propose a prognostic clinical score that facilitates selection of patients for repeat resection of recurrent ACC. STUDY DESIGN Patients who underwent curative-intent repeat resection for recurrent ACC at 1 of 13 academic medical centers participating in the US ACC Study Group were identified. End points included morbidity, mortality, and overall survival. RESULTS Fifty-six patients underwent repeat curative-intent resection for recurrent ACC (representing 21% of 265 patients who underwent resection for primary ACC) from 1997 to 2014. Median age was 52 years. Sites of resected recurrence included locoregional only (54%), lung only (14%), liver only (12%), combined locoregional and lung (4%), combined liver and lung (4%), and other distant sites (12%). Thirty-day morbidity and mortality rates were 40% and 5.4%, respectively. Cox regression analysis revealed that the presence of multifocal recurrence, disease-free interval <12 months, and extrapulmonary distant metastases were independent predictors of poor survival. A clinical score consisting of 1-point each for the 3 variables demonstrated good discrimination in predicting survival after repeat resection (5-year: 72% for 0 points, 32% for 1 point, 0% for 2 or 3 points; p = 0.0006, area under the curve = 0.78). CONCLUSIONS Long-term survival after repeat resection for recurrent ACC is feasible when 2 of the following factors are present: solitary tumor, disease-free interval >12 months, and locoregional or pulmonary recurrence.

Hyperthermic Intraperitoneal Chemotherapy for Primary or Recurrent Adrenocortical Carcinoma. A Single Center Study

“…HIPEC also proved effective in pursuing local/peritoneal control of recurrent disease, albeit this result appears less appreciable than in the SP setting. It is difficult to compare our result with those reported in literature [17][18][19][20], as patient characteristics and treatment strategies may be different as are the considered end points of the studies. However, the median l/pDFS of 12 months observed in our cohort was almost double compared to those previously reported.…”

“…Rescue surgery for early recurrence (median 7 months) was performed in 9/14 cases, all patients presented multiple nodules of recurrence, and those patients for whom a CC0 cytoreduction could not be achieved were treated. All these clinical conditions are negative prognostic factors [8,19,20], and the exclusion of possible bad performers could have positively influenced survival outcome. A second point regards the technical aspect of HIPEC.…”

Preoperative systemic inflammatory markers are prognostic indicators in recurrent adrenocortical carcinoma

“…Dy et al also identified patients with a disease‐free interval greater than 6 months to benefit from surgical resection . Tran et al found that favorable prognosis after reoperation may be expected when at least two of the following factors are present, namely: a solitary tumor, disease‐free interval greater than 12 months and locoregional or pulmonary recurrence. Finally, Patel et al identified elevated serum IGFBP2 to be associated with improved survival after reoperation in recurrent ACC.…”

“…12 Dy et al 10 also identified patients with a disease-free interval greater than 6 months to benefit from surgical resection. 10 Tran et al 27 should be used with caution and clinicians should be aware of these weaknesses. However, none of the clinical factors that were studied was significantly associated with elevated or reduced levels of LMR.…”

Recurrence-Free Survival Following Aggressive Multimodal Treatment of an Isolated Recurrence of Adrenocortical Carcinoma

“…Given the high rates of recurrence, salvage therapy options are important but remain currently underinvestigated. In patients with recurrent ACC, the benefits of repeat resection are contested, though, may be indicated in select patients who meet favorable criteria [8]. The utility of adjuvant mitotane or chemotherapy following resection of metastatic or recurrent disease remains unclear [8].…”