Adrenal Surgery for Synchronously Metastatic Adrenocortical Carcinoma: A Population‐Based Analysis
- 22 January 2021
- journal article
- research article
- Published by Wiley in World Journal of Surgery
- Vol. 45 (5), 1457-1465
- https://doi.org/10.1007/s00268-021-05957-0
Abstract
Background Metastatic adrenocortical carcinoma (ACC) is an aggressive cancer with poor prognosis, with limited treatment options. The survival benefit of adrenal surgery in patients with synchronous metastatic disease has not been well explored. Methods Patients with ACC with synchronous metastases were identified from the Surveillance, Epidemiology, and End Results database (2010–2016). The effect of adrenal surgery on different patterns of distant metastases was assessed. The overall survival was estimated by the Kaplan–Meier method. Multivariable Cox regression analysis was performed to identify prognostic factors associated with survival outcome. Results A total of 202 patients with synchronous metastatic ACC were identified from the SEER database, 76 (37.6%) patients underwent adrenal surgery. Compared to nonsurgical patients, patients who underwent adrenal surgery had a better survival (median overall survival: 4 vs. 13 months, P < 0.001). In sub-analyses, except for patients with liver metastases (P = 0.670), adrenalectomy could consistently confer a significant survival benefit in patients with lung metastases (P = 0.003), bone metastases (P = 0.020), and multiple metastases (P = 0.002). Cox regression analysis revealed that in addition to adrenalectomy [hazard ratio (HR) = 0.64, 95% confidence interval (CI) 0.45–0.92; P = 0.017], metastasectomy (HR = 0.48, 95% CI 0.26–0.86; P = 0.013), and chemotherapy (HR = 0.59, 95% CI 0.42–0.82; P = 0.002) were also associated with improved survival. Conclusions Our findings support the view that adrenal surgery may be associated with improved survival in patients with synchronous metastatic ACC (except for patients with liver metastases), and the metastatic sites have significant prognostic implications on survival outcomes with adrenal surgery.Funding Information
- the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University
This publication has 25 references indexed in Scilit:
- Operative intervention for recurrent adrenocortical cancerSurgery, 2013
- Adrenocortical carcinoma: A population-based study on incidence and survival in the Netherlands since 1993European Journal of Cancer, 2013
- Development and internal validation of an adrenal cortical carcinoma prognostic score for predicting the risk of metastasis and local recurrenceClinical Endocrinology, 2013
- Adrenal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upAnnals of Oncology, 2012
- Combination Chemotherapy in Advanced Adrenocortical CarcinomaThe New England Journal of Medicine, 2012
- Metastatic Adrenocortical Carcinoma: Results of 56 Pulmonary Metastasectomies in 24 PatientsThe Annals of Thoracic Surgery, 2011
- Operative management for recurrent and metastatic adrenocortical carcinomaJournal of Surgical Oncology, 2011
- Radiotherapy in adrenocortical carcinomaCancer, 2009
- Prognostic Parameters of Metastatic Adrenocortical CarcinomaJournal of Clinical Endocrinology & Metabolism, 2007
- Extent of Disease at Presentation and Outcome for Adrenocortical Carcinoma: Have We Made Progress?World Journal of Surgery, 2006