Curative Resection of Adrenocortical Carcinoma: Rates and Patterns of Postoperative Recurrence.
BACKGROUND
Adrenocortical carcinoma (ACC) is a rare malignancy. The aim of this study was to determine the incidence and patterns of recurrence after curative-intent surgery for ACC.


METHODS
Patients who underwent curative-intent resection for ACC between 1993 and 2014 were identified from 13 academic institutions participating in the United States ACC study group. Patients with metastasis or an R2 margin were excluded. Patterns and rates of recurrence were determined and classified as locoregional and distant recurrence.


RESULTS
A total of 180 patients with a median age of 52 years (interquartile range 43-61) were identified. Most patients underwent open surgery (n = 111, 64.5 %) and had an R0 resection margin (n = 117, 75.0 %). At last follow-up, 116 patients (64.4 %) had experienced recurrence (locoregional only, n = 41, 36.3 %; distant only, n = 51, 45.1 %; locoregional and distant, n = 21, 18.6 %). Median time to recurrence was 18.8 months. Several factors were associated with locoregional recurrence, including left-sided ACC location (odds ratio [OR] 2.71, 95 % confidence interval [CI] 1.06-6.89) and T3/T4 disease (reference T1/T2, OR 3.04, 95 % CI 1.19-7.80) (both p < 0.05). Distant recurrence was associated with larger tumor size (OR 1.11, 95 % CI 1.01-1.24) and T3/T4 disease (reference T1/T2, OR 5.23, 95 % CI 1.70-16.10) (both p < 0.05). Patients with combined locoregional and distant recurrence had worse survival (3- and 5-year survival: 39.5, 19.7 %) versus patients with distant-only (3- and 5-year survival 55.1, 43.3 %) or locoregional-only recurrence (3- and 5-year survival 81.4, 64.1 %) (p = 0.01).


CONCLUSIONS
Nearly two-thirds of patients experienced disease recurrence after resection of ACC. Although a subset of patients experienced recurrence with locoregional disease only, many patients experienced recurrence with distant disease as a component of recurrence and had a poor prognosis.
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neda
N
Amini
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Georgios Antonios
GA
Margonis
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Yuhree
Y
Kim
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Thuy B
TB
Tran
Department of Surgery, Emory University, Atlanta, GA, USA.
Lauren M
LM
Postlewait
Department of Surgery, Emory University, Atlanta, GA, USA.
Shishir K
SK
Maithel
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Tracy S
TS
Wang
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Douglas B
DB
Evans
Department of Surgery, New York University School of Medicine, New York, NY, USA.
Ioannis
I
Hatzaras
Department of Surgery, New York University School of Medicine, New York, NY, USA.
Rivfka
R
Shenoy
Department of Surgery, The Ohio State University, Columbus, OH, USA.
John E
JE
Phay
Department of Surgery, The Ohio State University, Columbus, OH, USA.
Kara
K
Keplinger
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ryan C
RC
Fields
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Linda X
LX
Jin
Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Sharon M
SM
Weber
Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Ahmed
A
Salem
Department of Surgery, University of California San Diego, San Diego, CA, USA.
Jason K
JK
Sicklick
Department of Surgery, University of California San Diego, San Diego, CA, USA.
Shady
S
Gad
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Adam C
AC
Yopp
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
John C
JC
Mansour
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Quan-Yang
QY
Duh
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Natalie
N
Seiser
Department of Surgery, Vanderbilt University, Nashville, TN, USA.
Carmen C
CC
Solorzano
Department of Surgery, Vanderbilt University, Nashville, TN, USA.
Colleen M
CM
Kiernan
Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Konstantinos I
KI
Votanopoulos
Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Edward A
EA
Levine
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
George A
GA
Poultsides
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. tpawlik1@jhmi.edu.
Timothy M
TM
Pawlik
D000306:Adrenal Cortex Neoplasms / Q000473:pathology / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D014481:United States / Q000453:epidemiology