The effect of hormonal secretion on survival in adrenocortical carcinoma: A multi-center study.

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
Jan 2024
Historique:
received: 04 02 2023
revised: 25 04 2023
accepted: 27 04 2023
pubmed: 10 11 2023
medline: 10 11 2023
entrez: 9 11 2023
Statut: ppublish

Résumé

Current evidence suggests that cortisol secreting adrenocortical carcinoma has worse prognosis compared to non-secreting adrenocortical carcinoma. However, the effect of other secretory subtypes is unknown. This multicenter study within the American-Australian-Asian Adrenal Alliance included adults with adrenocortical carcinoma (1997-2020). We compared overall survival and disease-free survival among cortisol secreting, mixed cortisol/androgen secreting, androgen secreting, and non-secreting adrenocortical carcinoma. Of the 807 patients (mean age 50), 719 included in the secretory subtype analysis: 24.5% were cortisol secreting, 13% androgen secreting, 28% mixed cortisol/androgen, 32.5% non-secreting, and 2% were mineralocorticoid secreting. Median overall survival and disease-free survival for the entire cohort were 60 and 9 months, respectively. Median overall survival was 36 months for cortisol, 30 for mixed, 60 for androgen secreting, and 115 for non-secreting adrenocortical carcinoma, P < .01. Median disease-free survival was 7 months for cortisol, 8 for mixed, 10 for androgen, and 12 for non-secreting adrenocortical carcinoma, P = .06. On multivariable analysis of age, sex, Ki67%, secretory subtype, stage, resection, and adjuvant therapy, predictors of worse overall survival were older age, higher Ki67%, stage IV, mixed secreting, R1, and no adjuvant therapy, P < .05. On subgroup analysis of R0 resection, predictors of worse overall survival included older age and higher Ki67%. Ki67% ≥40, stage III and cortisol secretion were associated with worse disease-free survival. Mixed cortisol/androgen secreting adrenocortical carcinoma was associated with worse overall survival, while cortisol or androgen secreting alone were not. Notably, among patients after R0 resection, secretory subtype did not affect overall survival. Cortisol secreting adrenocortical carcinoma demonstrated worse disease-free survival. Ki67% remained a strong predictor of worse overall survival and disease-free survival independent of stage.

Sections du résumé

BACKGROUND BACKGROUND
Current evidence suggests that cortisol secreting adrenocortical carcinoma has worse prognosis compared to non-secreting adrenocortical carcinoma. However, the effect of other secretory subtypes is unknown.
METHODS METHODS
This multicenter study within the American-Australian-Asian Adrenal Alliance included adults with adrenocortical carcinoma (1997-2020). We compared overall survival and disease-free survival among cortisol secreting, mixed cortisol/androgen secreting, androgen secreting, and non-secreting adrenocortical carcinoma.
RESULTS RESULTS
Of the 807 patients (mean age 50), 719 included in the secretory subtype analysis: 24.5% were cortisol secreting, 13% androgen secreting, 28% mixed cortisol/androgen, 32.5% non-secreting, and 2% were mineralocorticoid secreting. Median overall survival and disease-free survival for the entire cohort were 60 and 9 months, respectively. Median overall survival was 36 months for cortisol, 30 for mixed, 60 for androgen secreting, and 115 for non-secreting adrenocortical carcinoma, P < .01. Median disease-free survival was 7 months for cortisol, 8 for mixed, 10 for androgen, and 12 for non-secreting adrenocortical carcinoma, P = .06. On multivariable analysis of age, sex, Ki67%, secretory subtype, stage, resection, and adjuvant therapy, predictors of worse overall survival were older age, higher Ki67%, stage IV, mixed secreting, R1, and no adjuvant therapy, P < .05. On subgroup analysis of R0 resection, predictors of worse overall survival included older age and higher Ki67%. Ki67% ≥40, stage III and cortisol secretion were associated with worse disease-free survival.
CONCLUSION CONCLUSIONS
Mixed cortisol/androgen secreting adrenocortical carcinoma was associated with worse overall survival, while cortisol or androgen secreting alone were not. Notably, among patients after R0 resection, secretory subtype did not affect overall survival. Cortisol secreting adrenocortical carcinoma demonstrated worse disease-free survival. Ki67% remained a strong predictor of worse overall survival and disease-free survival independent of stage.

Identifiants

DOI: 10.1016/j.surg.2023.04.070 PMID: 37945477
pubmed: 37945477
pii: S0039-6060(23)00679-7
doi: 10.1016/j.surg.2023.04.070
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

80-89

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Alaa Sada (A)

Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: https://twitter.com/Aabdusada.

Trenton R Foster (TR)

Department of Surgery, Mayo Clinic, Rochester, MN.

Ruaa Al-Ward (R)

Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX.

Sahar Sawani (S)

Department of Medicine, Baylor College of Medicine, Houston, TX.

HElaine Charchar (H)

Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Reza Pishdad (R)

Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, MD. Electronic address: https://twitter.com/rpishdad.

Anat Ben-Shlomo (A)

Adrenal Program, Division of Endocrinology, Diabetes, and Metabolism, Cedars Sinai Medical Center, Los Angeles, CA.

Benzon M Dy (BM)

Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: https://twitter.com/Benzon_dy.

Melanie L Lyden (ML)

Department of Surgery, Mayo Clinic, Rochester, MN.

Emily Bergsland (E)

Department of Medicine, University of California San Francisco, San Francisco, CA.

Sina Jasim (S)

Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, Saint Louis, MO. Electronic address: https://twitter.com/Sina_jasim.

Nitya Raj (N)

Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

Jessica B Shank (JB)

Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE.

Oksana Hamidi (O)

Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX.

Amir H Hamrahian (AH)

Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, MD.

José L Chambô (JL)

Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Victor Srougi (V)

Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Hospital Moriah, São Paulo, Brazil.

Maria Cbv Fragoso (MC)

Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: https://twitter.com/Fragoso_mc.

Paul H Graham (PH)

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.

Mouhammed Amir Habra (MA)

Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX.

Irina Bancos (I)

Division of Endocrinology, Mayo Clinic, Rochester, MN. Electronic address: Bancos.Irina@mayo.edu.

Travis J McKenzie (TJ)

Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: Mckenzie.Travis@mayo.edu.

Classifications MeSH