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Cited by 91Adrenal and Paraganglionic TumorsRenal cell carcinoma treatmentAdrenal Hormones and Disorders

Influence of hormonal functional status on survival in adrenocortical carcinoma: systematic review and meta-analysis

Vanbrabant, T, Fassnacht, M, Assie, G, Dekkers, O M·2018·European Journal of Endocrinology
DOI 10.1530/eje-18-0450
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Abstract

Objective Adrenocortical carcinoma (ACC) is a malignancy with a poor prognosis. Many publications in ACC report on risk factors for a poor outcome; one risk factor studied is hormonal hypersecretion (cortisol, sex-hormones, steroid precursors or aldosterone). The aim of this systematic review was to study the association between hormonal secretion and recurrence or mortality in ACC. Design Systematic review and meta-analysis. We searched PubMed, EMBASE and The Cochrane library (January 2018) for cohort studies examining the association between hormonal secretion on overall or recurrence-free survival in ACC. Methods A random-effects model meta-analysis was performed to obtain a weighted relative risk comparing cortisol-secreting and/or androgen-secreting ACCs to non-secreting tumours regarding overall and recurrence-free survival. Risk of bias assessment was performed for all studies included. Results Nineteen publications were included representing a total of 3814 patients. Most studies were generally considered low/intermediate risk of bias. Meta-analysis showed higher mortality risk for cortisol-secreting ACCs, weighted relative risk 1.71 (95% CI: 1.18-2.47) combining studies that adjusted for tumour stage; also a higher recurrence risk was found for cortisol producing ACCs, relative risk 1.43 (95% CI: 1.18-1.73). Androgen secretion was not clearly associated with survival (RR: 0.82, 95% CI: 0.60-1.12). Conclusion This systematic review and meta-analysis show that cortisol-secreting ACCs are associated with a worse overall survival; future research is needed to establish whether this association points to negative effects of cortisol action, whether it signifies a more aggressive ACC subtype or whether cortisol is merely a prognostic marker.

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  • Cortisol hypersecretion leading to clinically evident Cushing's syndrome is recognized as a significant cause of morbidity and mortality due to increased risk of infection, metabolic, bone, and vascular complications.

    “However, cortisol hypersecretion leading to clinically evident Cushing’s syndrome is recognized as a significant cause of morbidity and mortality (134,135) due to increased risk of infection, metabolic, bone, and vascular complications (136).”

    From Adrenal incidentaloma (2020) · cites this paper as [136]

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  • Adrenal incidentaloma

    Sherlock, M., Scarsbrook, A., Abbas, A., Fraser, S., Limumpornpetch, P., Dineen, R., & Stewart, P. M. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnaa008 · Cited by 347 · see citing works

    “However, cortisol hypersecretion leading to clinically evident Cushing’s syndrome is recognized as a significant cause of morbidity and mortality (134,135) due to increased risk of infection, metabolic, bone, and vascular complications (136).”
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Related

Authors
Vanbrabant, T., Fassnacht, M., Assie, G., & Dekkers, O. M.
Affiliations
  • Leiden University Medical Center (NL)
  • University of Würzburg (DE)
  • 5Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Reference Center for Rare Adrenal Cancers, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
Corresponding author
Dekkers, O M
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2018-12
Volume
179
Issue
6
Pages
429-436
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-18-0450
OpenAlex
W2895298635
Cited by
91
References
34
Citations by year
2026: 7 · 2025: 10 · 2024: 12 · 2023: 15 · 2022: 12 · 2021: 17 · 2020: 14 · 2019: 3 · 2018: 1
FWCI
1.95
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
adrenocortical carcinoma, hormone hypersecretion, overall survival, recurrence-free survival, tumor recurrence, prognosis, prognostic factors, aldosterone, sex hormones
MeSH terms
Adrenal Cortex Neoplasms, Humans, Hydrocortisone, Cohort Studies, Survival Rate, Adrenocortical Carcinoma

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