Adrenocortical carcinoma: the influence of large vessel extension.
BACKGROUND
The impact of large vessel extension (LVE) as a prognostic factor for adrenocortical carcinoma (ACC) is not fully understood. This study aimed to assess outcome of ACC in the presence and absence of LVE.


METHODS
A retrospective review of 57 patients undergoing curative intent resection for ACC over 10 years is presented comparing those with and without LVE. LVE was defined as vascular wall invasion or intraluminal extension of the neoplasm into the inferior vena cava or renal vein. Preoperative diagnostics, operative details, pathology, overall survival (OS), and recurrence-free survival (RFS) were analyzed.


RESULTS
Multivariable regression analysis showed a significant association for decreased survival with Stage III and IV disease and LVE. Patients with LVE had more functional neoplasms, greater preoperative serum hormone levels, and more positive margins than those without LVE. Median OS was 6 years and RFS 3 years. Kaplan-Meier analysis demonstrated a significant decrease in OS and RFS with LVE. Median OS with and without LVE was 18 vs 111 months and median RFS was 11 vs 64 months. Three-year OS with and without LVE were 29% vs 93% and 3 year RFS was 15% vs 67%.


CONCLUSIONS
In addition to systemic and lymph node metastases, LVE is associated with poorer OS and RFS.
Department of Surgery, New York Presbyterian Hospital-Weill Cornell, New York, NY, USA.
Harma K
HK
Turbendian
Vivian E
VE
Strong
Meier
M
Hsu
Ronald A
RA
Ghossein
Thomas J
TJ
Fahey
D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012082:Renal Veins / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000473:pathology*