Journal Article

Adrenocortical Carcinoma: Impact of Surgical Margin Status on Long-Term Outcomes

Pawlik, Timothy M., Salem, Ahmed, Duh, Quan-Yang, Shenoy, Rivfka, Tran, Thuy B., Evans, Douglas B., Solorzano, Carmen C., Weber, Sharon M., Poultsides, George A., Hatzaras, Ioannis, Phay, John E., Mansour, John C., Sicklick, Jason K., Margonis, Georgios Antonios, Prescott, Jason D., Levine, Edward A., Seiser, Natalie, Jin, Linda X., Gad, Shady, Fields, Ryan C., Kiernan, Colleen M., Kim, Yuhree, Keplinger, Kara, Maithel, Shishir K., Wang, Tracy S., Yopp, Adam C., Postlewait, Lauren M., Votanopoulos, Konstantinos I.

2016

Overview

Background The influence of surgical margin status on long-term outcomes of patients undergoing adrenal resection for ACC remains not well defined. We studied the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ACC. Methods A total of 165 patients who underwent adrenal resection for ACC and met inclusion criteria were identified form a multi-institutional database. Clinicopathological data, pathologic margin status, and long-term outcomes were assessed. Patients were stratified into two groups based on margin status: R0 (margin >1 mm) versus R1. Results R0 resection was achieved in 126 patients (76.4 %), whereas 39 patients (23.6 %) had an R1 resection. Median and 5-year OS for patients undergoing R0 resection were 96.3 months and 64.8 % versus 25.1 months and 33.8 % for patients undergoing an R1 resection (both p  < 0.001). On multivariable analysis, surgical margin status was an independent predictor of worse OS (hazard ratio [HR] 2.22, 95 % confidence interval [CI] 1.03–4.77; p  = 0.04). The incidence of recurrence also differed between the two groups; 5-year RFS was 30.3 % among patients with an R0 resection versus 13.8 % among patients who had an R1 resection ( p  = 0.03). Lymph node metastasis (N1) was an independent predictor of RFS (HR 2.70, 95 % CI 1.04–6.99; p  = 0.04). Conclusions A positive margin after ACC resection was associated with worse long-term survival. Patient selection and an emphasis on surgical technique to achieve R0 margins are pivotal to optimizing the best chance for long-term outcome among patients with ACC.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adrenal Cortex Neoplasms - pathology / Adrenal Cortex Neoplasms - surgery / Adrenocortical Carcinoma - pathology / Adrenocortical Carcinoma - surgery / Cohort Studies / Endocrine Tumors / Female / Follow-Up Studies / Humans / Male / Medicine / Medicine & Public Health / Middle Aged / Neoplasm Recurrence, Local - pathology / Neoplasm Recurrence, Local - surgery / Neoplasm Staging / Oncology / Postoperative Complications / Prognosis / Surgery / Surgical Oncology / Survival Rate