JOURNAL of
ONCOLOGICAL
SCIENCES

ORIGINAL RESEARCH ARTICLE

Clinicopathological Features, Treatment Outcomes, and Prognostic Factors in Adrenocortical Carcinoma: A Single-Center Experience
Received Date : 18 May 2021
Accepted Date : 28 Oct 2021
Available Online : 12 Nov 2021
Doi: 10.37047/jos.2021-84514 - Article's Language: EN
J Oncol Sci. 2021;7(3):133-8
This is an open access article under the CC BY-NC-ND license
ABSTRACT
Objective: The study aimed to analyze clinicopathological features, treatment outcomes, and prognostic factors of patients with adrenocortical carcinoma (ACC). Material and Methods: The records of 25 patients with confirmed ACC were retrospectively examined who were followed up in our clinic. The clinical and pathological data were recorded. The prognosis was estimated using the Kaplan- Meier method, and prognostic variables were determined using Cox regression models. Results: The study included 21 patients, 19 (90.5%) of whom initially had Stage III or IV disease, and 18 (85.7%) had surgery for the primary tumor. In the subgroup with non-metastatic disease and primary tumor resection, patients who received adjuvant mitotane had significantly longer median disease-free survival than patients who had not (22.7 vs. 2.5 months, p=0.02). Five-year overall survival (OS) was 36%. De novo metastatic disease, primary tumor resection, and tumor functional status were the factors affecting OS significantly or having a trend in univariate analysis. Primary tumor resection was the only independent prognostic factor for OS after adjusting for other factors (hazard ratio=0.06, p=0.04). Conclusion: In our study population, adjuvant mitotane conferred a significant improvement in disease-free survival of patients with ACC who were operated on for localized disease. Primary tumor resection persisted in being a significant prognostic factor for OS.
KAYNAKLAR
  1. Fassnacht M, Dekkers OM, Else T, et al. European Society of Endocrinology Clinical Practice Guidelines on the management of adre nocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2018;179(4):G1-G46. [Crossref]  [PubMed] 
  2. Wanis KN, Kanthan R. Diagnostic and prognostic features in adrenocortical carcinoma: a single institution case series and review of the literature. World J Surg Oncol. Mar 2015;13: 117. [Crossref]  [PubMed]  [PMC] 
  3. Lerario AM, Moraitis A, Hammer GD. Genetics and epigenetics of adrenocortical tumors. Mol Cell Endocrinol. 2014;386(1-2):67-84. [Crossref]  [PubMed]  [PMC] 
  4. Lam AK. Adrenocortical carcinoma: Updates of clinical and pathological features after renewed World Health Organisation classification and pathology staging. Biomedicines. 2021;9(2):175. [Crossref]  [PubMed]  [PMC] 
  5. Ettaieb M, Kerkhofs T, van Engeland M, Haak H. Past, present and future of epigenetics in adrenocortical carcinoma. Cancers (Basel). 2020;12(5):1218. [Crossref]  [PubMed]  [PMC] 
  6. Fassnacht M, Terzolo M, Allolio B, et al; FIRM-ACT study group. Combination chemotherapy in advanced adrenocortical carcinoma. N Engl J Med. 2012;366(23):2189-2197. [PubMed] 
  7. Weiss LM, Medeiros LJ, Vickery AL Jr. Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol. 1989;13(3):202-206. [Crossref]  [PubMed] 
  8. Assié G, Antoni G, Tissier F, et al. Prognostic parameters of metastatic adrenocortical carcinoma. J Clin Endocrinol Metab. 2007;92(1): 148-154. [Crossref]  [PubMed] 
  9. Bilimoria KY, Shen WT, Elaraj D, et al. Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer. 2008;113(11):3130-3136. [Crossref]  [PubMed] 
  10. Paton BL, Novitsky YW, Zerey M, et al. Outcomes of adrenal cortical carcinoma in the United States. Surgery. 2006;140(6):914-920; discussion 919-920. [Crossref]  [PubMed] 
  11. Calabrese A, Basile V, Puglisi S, et al. Adjuvant mitotane therapy is beneficial in non-metastatic adrenocortical carcinoma at high risk of recurrence. Eur J Endocrinol. 2019; 180(6):387-396. [Crossref]  [PubMed] 
  12. Tang Y, Liu Z, Zou Z, Liang J, Lu Y, Zhu Y. Benefits of adjuvant mitotane after resection of adrenocortical carcinoma: A systematic review and meta-analysis. Biomed Res Int. Jun 2018;2018:9362108. [Crossref]  [PubMed]  [PMC] 
  13. Schteingart DE, Doherty GM, Gauger PG, et al. Management of patients with adrenal cancer: Recommendations of an international con sensus conference. Endocr Relat Cancer. 2005;12(3):667-680. [Crossref]  [PubMed] 
  14. Wang S, Gao WC, Chen SS, et al. Primary site surgery for metastatic adrenocortical carcinoma improves survival outcomes: an analysis of a population-based database. Onco Targets Ther. Nov 2017;10:5311-5315. [Crossref]  [PubMed]  [PMC] 
  15. Wang S, Chen SS, Gao WC, et al. Prognostic factors of adrenocortical carcinoma: An Analysis of the Surveillance Epidemiology and End Results (SEER) database. Asian Pac J Cancer Prev. 2017;18(10):2817-2823. [PubMed]  [PMC] 
  16. Lim JS, Lee SE, Kim JH, Kim JH. Characteristics of adrenocortical carcinoma in South Korea: a registry-based nationwide survey. Endocr Connect. 2020;9(6):519-529. [Crossref]  [PubMed]  [PMC]