title: MANAGEMENT OF ENDOCRINE DISEASE: Recurrence or new tumors after complete resection of pheochromocytomas and paragangliomas: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review the incidence and factors associated with recurrences or new tumors after apparent complete resection of pheochromocytoma or thoraco-abdomino-pelvic paraganglioma.
  
  
  METHODS
  A systematic review and meta-analysis of published literature was performed.
  
  
  METHODS
  Pubmed and Embase from 1980 to 2012 were searched for studies published in English on patients with non-metastatic pheochromocytoma or thoraco-abdomino-pelvic paraganglioma, complete tumor resection, postoperative follow-up exceeding 1 month, and recurrence or new tumor documented by pathology, hormonal dosages, or imaging tests. Incidence rates of new events after curative surgery were calculated for each study that had sufficient information and pooled using random-effect meta-analysis.
  
  
  RESULTS
  In total, 38 studies were selected from 3518 references, of which 36 reported retrospective cohorts from the USA, Europe, and Asia. Patient follow-up was neither standardized nor exhaustive in the included studies. A clear description of patient retrieval methods was available for nine studies and the follow-up protocol and patient flow for four studies. Only two studies used multivariable methods to assess potential predictors of postoperative events.The overall rate of recurrent disease from 34 studies was 0.98 events/100 person-years (95% confidence interval 0.71, 1.25). Syndromic diseases and paragangliomas were consistently associated with a higher risk of a new event in individual studies and in meta-regression analysis.
  
  
  CONCLUSIONS
  The risk of recurrent disease after complete resection of pheochromocytoma may be lower than that previously estimated, corresponding to five events for 100 patients followed up for 5 years after complete resection. Risk stratification is required to tailor the follow-up protocol after complete resection of a pheochromocytoma or paraganglioma. Large multicenter studies are needed to this end.
authors.affiliation: Faculty of MedicineUniversité Paris-Descartes, Paris, France Hypertension UnitAP-HP, Hôpital Européen Georges Pompidou, Paris, France Paris Cardiovascular Research CenterINSERM UMR970, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Amar
authors.affiliation: Hypertension UnitAP-HP, Hôpital Européen Georges Pompidou, Paris, France Paris Cardiovascular Research CenterINSERM UMR970, Paris, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lussey-Lepoutre
authors.affiliation: Department of Internal MedicineRadboud University Medical Center, Nijmegen, The Netherlands Department of Internal Medicine IIITechnische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Jacques W M
authors.initials: JW
authors.lastname: Lenders
authors.affiliation: Clinical Research UnitAP-HP, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Djadi-Prat
authors.affiliation: Faculty of MedicineUniversité Paris-Descartes, Paris, France Hypertension UnitAP-HP, Hôpital Européen Georges Pompidou, Paris, France Paris Cardiovascular Research CenterINSERM UMR970, Paris, France.
authors.forename: Pierre-Francois
authors.initials: PF
authors.lastname: Plouin
authors.affiliation: Faculty of MedicineSorbonne Universités, UPMC Univ Paris 06, Paris, France INSERMU1142, LIMICS, Paris, France Department of Internal MedicineAP-HP, Hôpital Tenon, Paris, France olivier.steichen@aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Steichen
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000473:pathology*; D010235:Paraganglioma / Q000473:pathology* / Q000601:surgery; D010673:Pheochromocytoma / Q000473:pathology* / Q000601:surgery