Objective: To assess outcome of stage IIIENSAT adrenocortical carcinoma (ACC) patients after complete macroscopic resection and prognostic factors for disease-free survival (DFS) and overall survival (OS).
Methods: A retrospective review of 68 stage III ACC patients treated surgically between 1994 and 2009 in the French COMETE network was performed. Characteristics of patients were reviewed by a single investigator as well as the Weiss score by experienced pathologists. There were 44 females and 24 males. The median age was 47 years (range 2175). Surgical excision was performed by laparotomy (91%) or laparoscopy. R1 resection and capsular effraction were notified in 18 and 16% of cases, respectively. Stage III-ENSAT definition included: T3 tumors (57%), T4 tumors (43%), N1 (10%) and or venous tumor thrombi (28%). Adjuvant treatment included mitotane therapy (96%) and radiotherapy of the tumor bed (7%). The median follow-up time was 36 months (5167). Uni and multivariate analyses were performed.
Results: Recurrence was evidenced in 57 (84%) patients within a median time of 9 months (171). Anatomic distribution of recurrences was: local only (37%), metastatic only (19%), local and metastatic (15%). The 1-year, 2-year, and 3-year DFS rate were 44, 26, and 18%, respectively. The 1-year, 2-year, and 3-year OS rate were respectively 88, 69, and 50%. Prognostic factors of DFS at multivariate study analysis were positive lymph node status and the size of the primary tumor. Prognostic factors of survival at multivariate analysis were age and positive lymph node status. Early recurrence (before 1 year) and mitotane plasma level <14 mg/l at the time of recurrence were associated with a poorer survival.
Conclusions: Our study demonstrated a high rate of recurrences after complete macroscopic resection of stage III-ENSAT ACC patients supporting a role for neo- and or adjuvant therapy in the future in this subgroup of patients.
30 Apr - 04 May 2011
European Society of Endocrinology