title: Surgery for recurrent adrenocortical carcinoma: A multicenter retrospective study.
abstract: Adrenocortical carcinoma is a rare neoplasm with a high rate of recurrence. We studied the impact of surgery on the survival in recurrent adrenocortical carcinoma patients.
  
  
  
  We performed a retrospective review of patients with recurrent adrenocortical carcinoma, managed in 5 French University Hospitals between 1980 and 2014. We compared surgery and medical management for ACC recurrence.
  
  
  
  Fifty-nine patients were included, 46 of whom had an initial R0 resection. Twenty-nine patients underwent reoperation for recurrence, while 30 had nonoperative treatments. Operated patients had a greater median overall survival after recurrence than nonoperated patients (91 vs 15 months; P < .001). Patients operated on for local or distant recurrence had similar overall survival (110 vs 91 months; P = .81). In nonoperated patients, types of medical managements did not impact survival. Surgery for recurrence (P = .037) and a disease-free interval between initial resection and recurrence >12 months (P = .059) were both prognostic factors for improved survival, whereas age, stage, and tumor size (P ≥ .2 each) were not. A Ki67 <25% tended to be associated with better overall survival (P = .051).
  
  
  
  Both surgery for recurrence and disease-free interval between the initial resection of an adrenocortical carcinoma and recurrence >12 months are associated with better overall survival.
authors.affiliation: Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Nantes, France.
authors.forename: Guénolé
authors.initials: G
authors.lastname: Simon
authors.affiliation: Chirurgie Générale et Endocrinienne, CHU Lille, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Pattou
authors.affiliation: Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallié
authors.affiliation: Service de Chirurgie Endocrinienne et Générale, CHU Lyon, Lyon, France.
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Lifante
authors.affiliation: Service de Chirurgie Digestive, Hépatobiliaire, Pancréatique, Endocrinienne et Cancérologique, CHU Nancy, Nancy, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Nominé
authors.affiliation: Service de Chirurgie Digestive Endocrinienne et Bariatrique, et Transplantation hépatique, CHU Tours, Tours, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Arnault
authors.affiliation: Service de Chirurgie Digestive Endocrinienne et Bariatrique, et Transplantation hépatique, CHU Tours, Tours, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: de Calan
authors.affiliation: Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Nantes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Caillard
authors.affiliation: Chirurgie Générale et Endocrinienne, CHU Lille, Lille, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Carnaille
authors.affiliation: Service de Chirurgie Digestive, Hépatobiliaire, Pancréatique, Endocrinienne et Cancérologique, CHU Nancy, Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brunaud
authors.affiliation: Service de Chirurgie Endocrinienne et Générale, CHU Lyon, Lyon, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Laplace
authors.affiliation: Chirurgie Générale et Endocrinienne, CHU Lille, Lille, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Caiazzo
authors.affiliation: Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Nantes, France. Electronic address: claire.blanchard@chu-nantes.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Blanchard
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D018268:Adrenocortical Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D000072700:Conservative Treatment; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome