Clinical Score Predicting Long-Term Survival after Repeat Resection for Recurrent Adrenocortical Carcinoma.
Adrenocortical carcinoma (ACC) is an aggressive malignancy typically resistant to chemotherapy and radiation. Surgery, even in the setting of locally recurrent or metastatic disease, remains the only potentially curative option. However, the subset of patients who will benefit from repeat resection in this setting remains ill defined. The objective of this study was to propose a prognostic clinical score that facilitates selection of patients for repeat resection of recurrent ACC.



Patients who underwent curative-intent repeat resection for recurrent ACC at 1 of 13 academic medical centers participating in the US ACC Study Group were identified. End points included morbidity, mortality, and overall survival.



Fifty-six patients underwent repeat curative-intent resection for recurrent ACC (representing 21% of 265 patients who underwent resection for primary ACC) from 1997 to 2014. Median age was 52 years. Sites of resected recurrence included locoregional only (54%), lung only (14%), liver only (12%), combined locoregional and lung (4%), combined liver and lung (4%), and other distant sites (12%). Thirty-day morbidity and mortality rates were 40% and 5.4%, respectively. Cox regression analysis revealed that the presence of multifocal recurrence, disease-free interval <12 months, and extrapulmonary distant metastases were independent predictors of poor survival. A clinical score consisting of 1-point each for the 3 variables demonstrated good discrimination in predicting survival after repeat resection (5-year: 72% for 0 points, 32% for 1 point, 0% for 2 or 3 points; p = 0.0006, area under the curve = 0.78).



Long-term survival after repeat resection for recurrent ACC is feasible when 2 of the following factors are present: solitary tumor, disease-free interval >12 months, and locoregional or pulmonary recurrence.
Department of Surgery, Stanford University, Stanford, CA.
Thuy B
TB
Tran
Department of Surgery, Emory University, Atlanta, GA.
Shishir K
SK
Maithel
Department of Surgery, The Johns Hopkins University, Baltimore, MD.
Timothy M
TM
Pawlik
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Tracy S
TS
Wang
Department of Surgery, New York University, New York, NY.
Ioannis
I
Hatzaras
Department of Surgery, The Ohio State University, Columbus, OH.
John E
JE
Phay
Department of Surgery, Washington University, St Louis, MO.
Ryan C
RC
Fields
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Sharon M
SM
Weber
Department of Surgery, University of California San Diego, San Diego, CA.
Jason K
JK
Sicklick
Department of Surgery, University of Texas Southwestern, Dallas, TX.
Adam C
AC
Yopp
Department of Surgery, University of California San Francisco, San Francisco, CA.
Quan-Yang
QY
Duh
Department of Surgery, Vanderbilt University, Nashville, TN.
Carmen C
CC
Solorzano
Department of Surgery, Wake Forest University, Winston-Salem, NC.
Konstantinos I
KI
Votanopoulos
Department of Surgery, Stanford University, Stanford, CA. Electronic address: gpoultsides@stanford.edu.
George A
GA
Poultsides
D000306:Adrenal Cortex Neoplasms / Q000401:mortality / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome