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Recurrence of Adrenal Cortical Carcinoma Following Resection: Surgery Alone Can Achieve Results Equal to Surgery Plus Mitotane
Abstract
Background A recent nonrandomized interinstitutional study reported that adjuvant mitotane following surgery for adrenocortical carcinoma (ACC) was associated with decreased recurrence. Because of the limitations of this study, we investigated the influences of surgery and adjuvant mitotane in a large series of ACC patients evaluated and treated at a single referral center.Study design Retrospective evaluation of patients followed at a single institution after surgery for ACC.Results 218 patients with ACC underwent primary resection either at the index institution [surgery index (SI), n = 28] or an outside institution [surgery outside (SO), n = 190] and had a median follow-up of 88 months. SI patients had a superior disease-free survival compared with SO patients (median 25 versus 12 months, P = 0.003), and SI patients also had a superior overall survival compared with SO patients (median not reached versus 44 months, P = 0.02). Factors predicting increased risk of recurrence on multivariate analysis were surgery at an outside institution [hazard ratio (HR) 2.56, 95% confidence interval (CI) 1.44-4.53, P = 0.001] and no treatment with adjuvant mitotane (HR 1.95, 95% CI 1.06-3.59, P = 0.03), and those predicting a poorer survival were advanced stage at presentation (P = 0.01) and surgery at an outside institution (HR 2.62, 95% CI 1.31-5.25, P = 0.007).Conclusions The recurrence rate of the index group (50%) in the current series, the overwhelming majority of whom did not receive adjuvant mitotane, is indistinguishable from that reported for those who received adjuvant mitotane (49%) in the recent interinstitutional report, emphasizing the importance of completeness of initial surgery in the management of patients with ACC.
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“Two studies published by the M.D. Anderson Cancer Center reported a recurrence rate of 86% in the OA group (154 patients) and 100% in the LA group (6 patients) (251, 257).”
From Adrenocortical carcinoma (2014) · cites this paper as [257]
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“Local recurrence and peritoneal carcinomatosis was more common in the LA group.”
From Adrenocortical carcinoma (2014) · cites this paper as [257]
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Metadata
- Authors
- Grubbs, E. G., Callender, G. G., Xing, Y., Perrier, N. D., Evans, D. B., Phan, A. T., & Lee, J. E.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Medical College of Wisconsin (US)
- Corresponding author
- Lee, Jeffrey E.
- ORCID
- Venue
- Annals of Surgical Oncology
- Published
- 2009-10-23
- Volume
- 17
- Issue
- 1
- Pages
- 263-270
- ISSN
- 1068-9265 (ISSN-L)
- 1534-4681
- OpenAlex
- W2046048324
- Cited by
- 158
- References
- 20
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 6 · 2022: 10 · 2021: 13 · 2020: 18 · 2019: 10 · 2018: 12 · 2017: 10 · 2016: 5 · 2015: 16 · 2014: 11 · 2013: 11 · 2012: 8
- FWCI
- 8.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Annals of Surgical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Oncology › Renal cell carcinoma treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- adrenocortical carcinoma, recurrence, adrenalectomy, disease-free survival, overall survival, stage at diagnosis, surgical resection
- MeSH terms
- Adolescent, Adrenal Cortex Neoplasms, Adult, Aged, Child, Child, Preschool, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mitotane, Neoplasm Recurrence, Local, Neoplasm Staging, Retrospective Studies, Survival Rate, Treatment Outcome, Chemotherapy, Adjuvant, Adrenocortical Carcinoma, Antineoplastic Agents, Hormonal, Young Adult
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