title: Curative Surgical Resection of Adrenocortical Carcinoma: Determining Long-term Outcome Based on Conditional Disease-free Probability.
abstract: To evaluate conditional disease-free survival (CDFS) for patients who underwent curative intent surgery for adrenocortical carcinoma (ACC).
  
  
  
  ACC is a rare but aggressive tumor. Survival estimates are usually reported as survival from the time of surgery. CDFS estimates may be more clinically relevant by accounting for the changing likelihood of disease-free survival (DFS) according to time elapsed after surgery.
  
  
  
  CDFS was assessed using a multi-institutional cohort of patients. Cox proportional hazards models were used to evaluate factors associated with DFS. Three-year CDFS (CDFS3) estimates at "x" year after surgery were calculated as follows: CDFS3 = DFS(x+3)/DFS(x).
  
  
  
  One hundred ninety-two patients were included in the study cohort; median patient age was 52 years. On presentation, 36% of patients had a functional tumor and median size was 11.5 cm. Most patients underwent R0 resection (75%) and 9% had N1 disease. Overall 1-, 3-, and 5-year DFS was 59%, 34%, and 22%, respectively. Using CDFS estimates, the probability of remaining disease free for an additional 3 years given that the patient had survived without disease at 1, 3, and 5 years, was 43%, 53%, and 70%, respectively. Patients with less favorable prognosis at baseline demonstrated the greatest increase in CDFS3 over time (eg, capsular invasion: 28%-88%, Δ60% vs no capsular invasion: 51%-87%, Δ36%).
  
  
  
  DFS estimates for patients with ACC improved dramatically over time, in particular among patients with initial worse prognoses. CDFS estimates may provide more clinically relevant information about the changing likelihood of DFS over time.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Margonis
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Prescott
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Thuy B
authors.initials: TB
authors.lastname: Tran
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Postlewait
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Wang
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Glenn
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, NY.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Hatzaras
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, NY.
authors.forename: Rivfka
authors.initials: R
authors.lastname: Shenoy
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH.
authors.forename: John E
authors.initials: JE
authors.lastname: Phay
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH.
authors.forename: Kara
authors.initials: K
authors.lastname: Keplinger
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Linda X
authors.initials: LX
authors.lastname: Jin
authors.affiliation: Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.affiliation: Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, CA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Sicklick
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, CA.
authors.forename: Shady
authors.initials: S
authors.lastname: Gad
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Yopp
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: John C
authors.initials: JC
authors.lastname: Mansour
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA.
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Seiser
authors.affiliation: Department of Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Solorzano
authors.affiliation: Department of Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Kiernan
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Votanopoulos
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D055815:Young Adult