Surgical Outcomes of Adrenocortical Carcinoma; 20 Years of Experience in a Single Institution
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Purpose: Adrenocortical carcinoma (ACC) is a rare malignant tumor. Early detection is difficult and prognosis is poor. We report on 20 years of ACC surgical experience at our institution. Methods: This study included 32 ACC patients who underwent surgical resection at the Department of Surgery of the Yonsei University Health System in South Korea between January 1990 and February 2012. We reviewed these 32 patients and retrospectively analyzed long-term clinical outcomes and prognosis after radical surgery for ACC. Results: The median age of the 32 patients at diagnosis was 42.25 years (range 3∼81 years). There were 16 (50%) female and 16 (50%) male patients. Mean tumor size was 12.36 cm (range 1.8∼20 cm). Twenty-five patients (78.12%) had nonfunctioning tumors while the other seven patients (21.87%) had functioning tumors. Seventeen patients (53.12%) were classified as stage II, two (6.25%) as stage III, and 13 (40.62%) as stage IV. Fourteen patients underwent radical surgical resection, while 14 patients received adjuvant chemotherapy, two received adjuvant radiotherapy, and two received adjuvant chemoradiation. Four patients were lost to follow-up. Among the remaining 28 patients, 15 patients survived. The 5- and 10-year overall survival was 60.6% and 37.8%, respectively (median survival=85±24.3 months). Seventeen patients (53%) experienced disease recurrence. Five- and 10-year recurrence-free survival was 41.5% and 29.7%, respectively (median survival=18±5.5 months). Conclusion: Early stage at diagnosis and surgical resection were the most important prognostic factors associated with prolonged survival. The role of additional therapy remains controversial and new agents should continually be evaluated for efficacy.
Abstract
Purpose: Adrenocortical carcinoma (ACC) is a rare malignant tumor. Early detection is difficult and prognosis is poor. We report on 20 years of ACC surgical experience at our institution. Methods: This study included 32 ACC patients who underwent surgical resection at the Department of Surgery of the Yonsei University Health System in South Korea between January 1990 and February 2012. We reviewed these 32 patients and retrospectively analyzed long-term clinical outcomes and prognosis after radical surgery for ACC. Results: The median age of the 32 patients at diagnosis was 42.25 years (range 3∼81 years). There were 16 (50%) female and 16 (50%) male patients. Mean tumor size was 12.36 cm (range 1.8∼20 cm). Twenty-five patients (78.12%) had nonfunctioning tumors while the other seven patients (21.87%) had functioning tumors. Seventeen patients (53.12%) were classified as stage II, two (6.25%) as stage III, and 13 (40.62%) as stage IV. Fourteen patients underwent radical surgical resection, while 14 patients received adjuvant chemotherapy, two received adjuvant radiotherapy, and two received adjuvant chemoradiation. Four patients were lost to follow-up. Among the remaining 28 patients, 15 patients survived. The 5- and 10-year overall survival was 60.6% and 37.8%, respectively (median survival=85±24.3 months). Seventeen patients (53%) experienced disease recurrence. Five- and 10-year recurrence-free survival was 41.5% and 29.7%, respectively (median survival=18±5.5 months). Conclusion: Early stage at diagnosis and surgical resection were the most important prognostic factors associated with prolonged survival. The role of additional therapy remains controversial and new agents should continually be evaluated for efficacy.
참고문헌 (33)
- Ng L, "Adrenocortical carcinoma: diagnosis, evaluation and treatment", J Urol, 169, pp.5~11 (2003)
- Kebebew E, "Extent of disease at presentation and outcome for adrenocortical carcinoma:have we made progress?", World J Surg, 30, pp.872~878 (2006)
- Kerkhofs TM, "Adrenocortical carcinoma: a population-based study on incidence and survival in the Netherlands since 1993", Eur J Cancer, 49, pp.2579~2586 (2013)
- Barzon L, "Adrenocortical carcinoma: experience in 45 patients", Oncology, 54, pp.490~496 (1997)
- Hutter AM Jr, "Adrenal cortical carcinoma. Clinical features of 138 patients", Am J Med, 41, pp.572~580 (1966)
- Luton JP, "Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy", N Engl J Med, 322, pp.1195~1201 (1990)
- Williams GH DR, "Harrison's Principles of Internal Medicine:Companion Handbook", pp.1758~ (1988), McGraw-Hill
- Allolio B, "Management of adrenocortical carcinoma", Clin Endocrinol, 60, pp.273~287 (2004)
- Haak HR, "Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients", Br J Cancer, 69, pp.947~951 (1994)
- Baudin E, "Impact of monitoring plasma 1,1-dichlorodiphenildichloroethane (o,p'DDD) levels on the treatment of patients with adrenocortical carcinoma", Cancer, 92, pp.1385~1392 (2001)
- Hermsen IG, "Plasma concentrations of o,p'DDD, o,p'DDA, and o,p'DDE as predictors of tumor response to mitotane in adrenocortical carcinoma: results of a retrospective ENS@T multicenter study", J Clin Endocrinol Metab, 96, pp.1844~1851 (2011)
- Zografos GC, "Adrenal adenocarcinoma: a review of 53 cases", J Surg Oncol, 55, pp.160~164 (1994)
- Icard P, "Adrenocortical carcinoma in surgically treated patients: a retrospective study on 156 cases by the French Association of Endocrine Surgery", Surgery, 112, pp.972~979 (1992)
- Edge SB, "AJCC Cancer Staging Manual", pp.516~517 (2010), Springer
- Fassnacht M, "German Adrenocortical Carcinoma Registry Group; European Network for the Study of Adrenal Tumors. Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma:proposal for a Revised TNM Classification", Cancer, 115, pp.243~250 (2009)
- Sasano H, "Recent advances in histopathology and immunohistochemistry of adrenocortical carcinoma", Endocr Pathol, 17, pp.345~354 (2006)
- Aubert S, "Weiss system: a still in-use diagnostic tool for the assessment of adrenocortical malignancy", Ann Pathol, 25, pp.545~554 (2005)
- Henry I, "Tumor-specific loss of 11p15.5 alleles in del11p13 Wilms tumor and in familial adrenocortical carcinoma", Proc Natl Acad Sci U S A, 86, pp.3247~3251 (1989)
- Yano T, "Genetic changes in human adrenocortical carcinomas", J Natl Cancer Inst, 81, pp.518~523 (1989)
- Else T, "Association of adrenocortical carcinoma with familial cancer susceptibility syndromes", Mol Cell Endocrinol, 351, pp.66~70 (2012)
- Gaujoux S, "Recommendation for standardized surgical management of primary adrenocortical carcinoma", Surgery, 152, pp.123~132 (2012)
- Reibetanz J, "Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma", Ann Surg, 255, pp.363~369 (2012)
- Gröndal S, "Adrenocortical carcinoma. A retrospective study of a rare tumor with a poor prognosis", Eur J Surg Oncol, 16, pp.500~506 (1990)
- Thompson NW, "Diagnosis and treatment of functioning and nonfunctioning adrenocortical neoplasms including incidentalomas", Surg Clin North Am, 67, pp.423~436 (1987)
- Hogan TF, "A clinical and pathological study of adrenocortical carcinoma: therapeutic implications", Cancer, 45, pp.2880~2883 (1980)
- Wajchenberg BL, "Adrenocortical carcinoma:clinical and laboratory observations", Cancer, 88, pp.711~736 (2000)
- Schteingart DE, "Conventional and novel strategies in the treatment of adrenocortical cancer", Braz J Med Biol Res, 33, pp.1197~1200 (2000)
- Terzolo M, "Adjuvant mitotane treatment for adrenocortical carcinoma", N Engl J Med, 356, pp.2372~2380 (2007)
- Terzolo M, "Mitotane levels predict the outcome of patients with adrenocortical carcinoma treated adjuvantly following radical resection", Eur J Endocrinol, 169, pp.263~270 (2013)
- Berruti A, "Mitotane associated with etoposide, doxorubicin, and cisplatin in the treatment of advanced adrenocortical carcinoma. Italian Group for the Study of Adrenal Cancer", Cancer, 83, pp.2194~2200 (1998)
- Abraham J, "A phase II trial of combination chemotherapy and surgical resection for the treatment of metastatic adrenocortical carcinoma:continuous infusion doxorubicin, vincristine, and etoposide with daily mitotane as a P-glycoprotein antagonist", Cancer, 94, pp.2333~2343 (2002)
- Polat B, "Radiotherapy in adrenocortical carcinoma", Cancer, 115, pp.2816~2823 (2009)
- Lughezzani G, "The European Network for the Study of Adrenal Tumors staging system is prognostically superior to the international union against cancer-staging system: a North American validation", Eur J Cancer, 46, pp.713~719 (2010)