The role of surgery in the management of recurrent adrenocortical carcinoma
| Autor: | Felix Beuschlein, Stefanie Hahner, Matthias Kroiss, Wiebke Fenske, Ilknur Erdogan, Holger S. Willenberg, Silke Klose, Anke Heidemeier, David Brix, Joachim Reibetanz, Bruno Allolio, Christian Fottner, Martin Fassnacht, C. Ronchi, Christian Jurowich, Jens Waldmann, Timo Deutschbein, Marcus Quinkler |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Multivariate analysis Adolescent Endocrinology Diabetes and Metabolism Clinical Biochemistry Context (language use) Biochemistry Young Adult Endocrinology Recurrence medicine Adrenocortical Carcinoma Adrenocortical carcinoma Humans Progression-free survival Registries Young adult Survival analysis Aged Retrospective Studies Proportional hazards model business.industry Biochemistry (medical) Editorials Retrospective cohort study Adrenalectomy Middle Aged medicine.disease Survival Analysis Adrenal Cortex Neoplasms Surgery Treatment Outcome Female business |
| Zdroj: | The Journal of clinical endocrinology and metabolism. 98(1) |
| ISSN: | 1945-7197 |
| Popis: | Surgery is the standard of care for localized adrenocortical carcinomas, but its role for recurrent disease is not well defined.Our objective was to evaluate clinical outcome after surgery for recurrence.We conducted a retrospective analysis in 154 patients with first recurrence after initial radical resection from the German Adrenocortical Carcinoma Registry.We evaluated progression-free survival (PFS) and overall survival (OS) by Kaplan-Meier method and identified prognostic factors by Cox regression analysis.A total of 101 patients underwent repeated surgery (radical resection, n = 78), and 99 received (additional) nonsurgical therapy. After a median of 6 (1-221) months, 144 patients (94%) experienced progression. Multivariate analysis adjusted for age, sex, tumor burden, time to first recurrence (TTFR), surgery for recurrence (including resection status), and additional therapy indicated that only two factors were significantly associated with shorter PFS [hazard ratio for progression: for TTFR ≤ 12 months, 1.8 (95% confidence interval = 1.3-2.6) vs. TTFR12 months; for macroscopically incomplete resection, 3.4 (1.5-7.9), and for no surgery, 3.4 (1.6-7.0) vs. microscopically complete (R0)-resection and OS [hazard ratio for death: for TTFR12 months, 3.1 (2.0-4.7) vs. TTFR ≤ 12 months; for macroscopically incomplete resection, 2.7 (1.1-6.9), and no surgery, 4.2 (1.8-9.6) vs. R0-resection]. Patients who had both TTFR over 12 months and R0-resection of recurrent tumors (n = 22) had the best prognosis (median PFS, 24 months; median OS,60 months).The best predictors of prolonged survival after first recurrence are TTFR over 12 months and R0-resection. Our data suggest that patients with longer TTFR and tumors amenable to radical resection should be operated, whereas individualized treatment decisions are needed for patients with short TTFR or with not completely resectable tumors. |
| Databáze: | OpenAIRE |
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