Curative Surgical Resection of Adrenocortical Carcinoma

Kim, Yuhree; Margonis, Georgios Antonios; Prescott, Jason D.; Tran, Thuy B.; Postlewait, Lauren M.; Maithel, Shishir K.; Wang, Tracy; 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; Solórzano, Carmen C.; Kiernan, Colleen M.; Votanopoulos, Konstantinos I.; Levine, Edward A.; Poultsides, George A.; Pawlik, Timothy M.

doi:10.1097/sla.0000000000001527

Cited by 34 publications

(17 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Compared with cumulative survival, CS could reflect changes in survival probability due to prolonged survival, and is more useful for predicting prognosis 19 - 21 . Donald et al have reported the conditional survival of patients with different stages of breast cancer between 1983 and 1987 11 .…”

Section: Discussionmentioning

confidence: 99%

Conditional Survival of female patients with operable invasive Breast Cancer in US: A population-based study

Ai¹,

Wang²,

Kong³

et al. 2020

J. Cancer

View full text Add to dashboard Cite

Background: Conditional survival (CS) is used to describe the dynamic possibility of survival, considering the changes of death risk with time lapsing. This study aimed to estimate the conditional disease-specific survival (CDS) for the female with operable invasive breast cancer. Methods: The data was obtained from Surveillance, Epidemiology, and End Result Program of the National Cancer Institute. The hazard rate was calculated using kernel density smoothing method. The disease-specific survival (DSS) rates were estimated and compared using Kaplan-Meier method and log-rank test. The Cox regression model was used to adjust confounding factors. The CDS was calculated by CDS(y|x)=DSS(x + y)/DSS(x), where DSS(x) representatives the DSS at x year. Results: The 5-year, 10-year, and 15-year DSS was 88.7%, 82.0%, and 78.3%, respectively. The hazard rate after surgery increased initially and peaked at about 1.5 years, then decreased gradually. Meanwhile, the CDS decreased just after surgery then increased continuously, which showed a contrary trend with hazard rate. Patients with high risk factors had greater survival gap between cumulative DSS and CDS. The changing trend of CDS in patients with high risk factors was more significant, and the CDS gap between low-risk patients and high-risk patients gradually decreased over time. Conclusion: CS could provide a more precise long-term prognostic evaluation compared to traditional cumulative survival, especially for long-time survivors with high risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Conditional Survival of female patients with operable invasive Breast Cancer in US: A population-based study

Ai¹,

Wang²,

Kong³

et al. 2020

J. Cancer

View full text Add to dashboard Cite

show abstract

“…Thirty-five studies reporting on risk factors for recurrence and/or mortality, and that included more than 100 patients with histologically proven ACC, were analyzed (1,8,20,25,26,29,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82) (see Appendix 2 for details of studies included, and Appendix 3 for an overview of all prognostic factors studied). The threshold of 100 cases was defined upfront as with n = 100 and an expected number of deaths of 50, statistical power was considered sufficient.…”

Section: Clinical Question 2: Prognostic Factorsmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Dekkers

Else

et al. 2018

European Journal of Endocrinology

658

867

View full text Add to dashboard Cite

Adrenocortical carcinoma (ACC) is a rare and in most cases steroid hormone-producing tumor with variable prognosis. The purpose of these guidelines is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with ACC based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions, which we judged as particularly important for the management of ACC patients and performed systematic literature searches: (A) What is needed to diagnose an ACC by histopathology? (B) Which are the best prognostic markers in ACC? (C) Is adjuvant therapy able to prevent recurrent disease or reduce mortality after radical resection? (D) What is the best treatment option for macroscopically incompletely resected, recurrent or metastatic disease? Other relevant questions were discussed within the group. Selected Recommendations: (i) We recommend that all patients with suspected and proven ACC are discussed in a multidisciplinary expert team meeting. (ii) We recommend that every patient with (suspected) ACC should undergo careful clinical assessment, detailed endocrine work-up to identify autonomous hormone excess and adrenal-focused imaging. (iii) We recommend that adrenal surgery for (suspected) ACC should be performed only by surgeons experienced in adrenal and oncological surgery aiming at a complete en bloc resection (including resection of oligo-metastatic disease). (iv) We suggest that all suspected ACC should be reviewed by an expert adrenal pathologist using the Weiss score and providing Ki67 index. (v) We suggest adjuvant mitotane treatment in patients after radical surgery that have a perceived high risk of recurrence (ENSAT stage III, or R1 resection, or Ki67 >10%). (vi) For advanced ACC not amenable to complete surgical resection, local therapeutic measures (e.g. radiation therapy, radiofrequency ablation, chemoembolization) are of particular value. However, we suggest against the routine use of adrenal surgery in case of widespread metastatic disease. In these patients, we recommend either mitotane monotherapy or mitotane, etoposide, doxorubicin and cisplatin depending on prognostic parameters. In selected patients with a good response, surgery may be subsequently considered. (vii) In patients with recurrent disease and a disease-free interval of at least 12 months, in whom a complete resection/ablation seems feasible, we recommend surgery or alternatively other local therapies. Furthermore, we offer detailed recommendations about the management of mitotane treatment and other supportive therapies. Finally, we suggest directions for future research.

show abstract

“…Larger C-index and AUC value show higher ability to distinguish patients from different survival outcomes. Last, Kaplan-Meier curves were plotted over patients grouped by risks predicted from the nomogram to further assess calibration [18]. A two tailed p<0.05 was considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Overall Survival and Competing Risks of Survival in Patients With Early Stage Breast Cancer Using a Comprehensive Nomogram

Liu

Cao

et al. 2019

Preprint

View full text Add to dashboard Cite

BackgroundPatients with early stage breast cancer (BC) live long but accompany with competing comorbidities. This study aims to estimate the impact of cancer and non-cancer causes of death in early stage BC patients, and further quantify the survival differences. MethodsPatients diagnosed with breast cancer between 2010 and 2016 from the Surveillance, Epidemiology, and End Results database were enrolled in the study. Cumulative incidence function (CIF) for cause-specific death and other causes of death were estimated, and the differences were tested by Gray’s test. Nomogram for estimating 3-, 4-, and 5-year overall survival, cancer-specific survival and other-cause-specific survival was established based on Cox regression analysis and Fine and Gray’s competing risk analysis. The discriminative ability, calibration and precision of the nomogram was evaluated and compared using C statistics, calibration plots and the area under receiver operating characteristic curve. Results196304 eligible patients with early-stage BC patients were enrolled in this study. Prolonged overall survival (OS) was associated with younger age, well differentiation, smaller tumor size, Luminal subtype and presence of surgery ( p <0.001). For competing events, Fine and Gray's competing risk analysis was used to validate the predictors: i ncreasing age, poorer differentiation, larger tumor size, triple negative subtype, HER2 enriched subtype and absence of surgery for cancer-specific mortality (CSM); and increasing age, larger tumor size and absence of surgery for other-cause-specific mortality (OCSM). The established nomogram was well calibrated, and displayed good discrimination in both training cohort and validation cohort by calibration plots (Figure 4), with a concordance index of 0.801 (95% CI, 0.795-0.806; p =0.003) for OS prediction; 0.830 (95% CI, 0.824-0.836; p =0.003) for CSM prediction and 0.806 (95% CI, 0.798-0.814; p =0.004) for OCSM prediction. Furthermore, the AUC values for predicting survival and death were: OS, 80.2% (3-year), 79.5% (4-year), and 78.7% (5-year); CSM, 83.0% (3-year), 81.7% (4-year), and 80.3% (5-year); OCSM 81.3% (3-year), 80.8% (4-year), and 81.7% (5-year) (Figure 5). ConclusionsWe evaluated OS and CIF of cancer-specific death and other-cause-specific death in patients with early stage BC based on Cox regression analysis and Fine and Gray’s competing risk analysis and developed the first comprehensive prognostic nomogram.

show abstract

Curative Surgical Resection of Adrenocortical Carcinoma

Cited by 34 publications

References 42 publications

Conditional Survival of female patients with operable invasive Breast Cancer in US: A population-based study

Conditional Survival of female patients with operable invasive Breast Cancer in US: A population-based study

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors

Evaluating Overall Survival and Competing Risks of Survival in Patients With Early Stage Breast Cancer Using a Comprehensive Nomogram

Contact Info

Product

Resources

About