Operative management for recurrent and metastatic adrenocortical carcinoma

Abstract

Objective: A review of all resections for recurrent or metastatic ACC was performed to identify patients who might benefit from a surgical approach, and to identify factors that might aid in prognosis among patients with metastatic disease.

Summary background data: Adrenocortical carcinoma (ACC) is a rare tumor, with frequent recurrences and metastases even after complete resection. Chemotherapy has limited efficacy, and surgical resection of metastatic ACC remains controversial.

Methods: A retrospective review was performed of all patients who underwent surgical intervention for metastatic ACC in a single tertiary center from 1977 to 2009. All available clinicopathologic data were analyzed to determine potential factors associated with response to treatment and survival.

Results: Fifty-seven patients underwent 116 procedures for recurrent or metastatic disease. Twenty-three resections were for liver metastases, 48 for pulmonary metastases, 22 for abdominal disease including local recurrences, and 13 were for metastases at other sites. Median and 5-year survivals from time of first metastasectomy were 2.5 years, and 41%, respectively. The median survival of patients with DFI <12 months was 1.7 years, compared to 6.6 years for patients with DFI >12 months (P = 0.015). Median survival for right versus left-sided primaries was 1.9 years versus 3.8 years (P = 0.03). Liver metastases were more common with right-sided primaries (67% vs. 41%, P = 0.05). Chemotherapy had no impact on survival.

Conclusions: Resection of recurrent or metastatic ACC is safe, and may result in prolongation of survival in selected patients with DFI greater than 1 year.

Copyright © 2011 Wiley Periodicals, Inc.

Figures

Fig. 1

Overall survival from the time of first metastasectomy for 57 patients who all underwent at least one metastasectomy. At 5 years, the overall survival was 41%, with a median survival of 2.5 years and a range of 2.8 months to 12+ years.

Fig. 2

Prognostic factors. A: Disease-free interval longer than 12 months was associated with longer survival (6.6 years vs. 1.7 years, P = 0.015). B: Left-sided primary was associated with a longer survival (3.8 years vs. 1.9 years, P = 0.034).