K. M. Prendergast1, P. Marincola Smith2, C. M. Kiernan2, S. K. Maithel4, J. D. Prescott5, T. M. Pawlik5, T. S. Wang6, J. Glenn6, I. Hatzaras7, J. E. Phay8, L. A. Shirley8, R. C. Fields9, S. M. Weber10, J. K. Sicklick11, A. C. Yopp12, J. C. Mansour12, Q. Duh13, E. A. Levine14, G. A. Poultsides3, C. C. Solorzano2 1Vanderbilt University Medical Center,School Of Medicine,Nashville, TN, USA 2Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA 3Stanford University School of Medicine,Department Of Surgery,Palo Alto, CA, USA 4Emory University School Of Medicine,Department Of Surgical Oncology,Atlanta, GA, USA 5Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 6Medical College Of Wisconsin,Department Of Surgery,Milwaukee, WI, USA 7New York University School Of Medicine,Department Of Surgery,New York, NY, USA 8Ohio State University,Department of Surgery,Columbus, OH, USA 9Washington University School of Medicine,Department Of Surgery,St. Louis, MO, USA 10University Of Wisconsin School of Medicine and Public Health,Department Of Surgery,Madison, WI, USA 11University Of California – San Diego,Department Of Surgery,San Diego, CA, USA 12University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA 13University Of California – San Francisco,Department Of Surgery,San Francisco, CA, USA 14Wake Forest University School Of Medicine,Department Of Surgery,Winston-Salem, NC, USA
Introduction: Adrenocortical carcinoma (ACC) is a rare and aggressive cancer and many patients present with metastases. We describe the features of patients presenting with metastatic disease who underwent synchronous metastasectomy and contrast them with patients who underwent metastasectomy for recurrent ACC.
Methods: Adult patients who underwent resection for metastatic ACC from 1993-2014 at 13 participating institutions of the US-ACC Group were analyzed retrospectively. Patients were categorized as “synchronous” if they underwent metastasectomy at the time of their index adrenalectomy or “metachronous” if they underwent resection for disease recurrence. Differences between groups were summarized using descriptive statistics. Factors associated with overall survival were assessed by univariate analysis.
Results: 84 patients with ACC underwent metastasectomy: 26 (31%) synchronous and 58 (69%) metachronous. Demographics were similar between groups. Patients in the synchronous group had more right-sided (54 vs. 40%) and glucocorticoid-secreting tumors (27 vs. 16%); however these differences were not significant (p=0.341 and p=0.304, respectively). The synchronous group had a higher percentage of T4 tumors at index resection (42 vs. 3%, p<0.001); both groups had a similar proportion of N1 disease (11 vs. 7%, p=0.734). There were no significant differences between groups in the rate of treatment with neoadjuvant chemotherapy or adjuvant chemotherapy, mitotane, or radiation. The most common site of metastasectomy in the synchronous group was liver (58%), followed by lung (23%). The most common site of metastasectomy in the metachronous group was local (36%), followed by multiple sites (17%). The metachronous group had prolonged median survival following index resection (86.3 vs. 17.3 months, p<0.001) and following first metastasectomy (36.9 vs. 17.3 months, p=0.007). In the synchronous group, patients with R0 resection had improved survival over patients with R1 or R2 resection (p=0.008), while margin status at metastasectomy was not significantly associated with survival in the metachronous group (p=0.452).
Conclusion: Select patients with metastatic ACC may benefit from metastasectomy. Compared to patients with metachronous metastases, those with synchronous metastases have shortened survival following metastasectomy. This study highlights the need for future studies examining differences in tumor biology that might influence treatment decisions in these two distinct patient populations.
