Outcomes of Adjuvant Mitotane after Resection of Adrenocortical Carcinoma: A 13-Institution Study by the US Adrenocortical Carcinoma Group

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• 作者：Lauren M. Postlewait ; MD^a ; Cecilia G. Ethun ; MD^a ; Thuy B. Tran ; MD^b ; Jason D. Prescott ; MD ; PhD^e ; Timothy M. Pawlik ; MD ; MPH ; PhD ; FACS^e ; Tracy S. Wang ; MD ; MPH ; FACS^f ; Jason Glenn ; MD^f ; Ioannis Hatzaras ; MD ; MPH ; FACS^h ; Rivfka Shenoy ; MD^h ; John E. Phay ; MD ; FACSⁱ ; Kara Keplinger ; MDⁱ ; Ryan C. Fields ; MD ; FACS^j ; Linda X. Jin ; MD^j ; Sharon M. Weber ; MD ; FACS^g ; Ahmed Salem ; MD^g ; Jason K. Sicklick ; MD ; FACS^c ; Shady Gad ; MD^c ; Adam C. Yopp ; MD ; FACS^k ; John C. Mansour ; MD ; FACS^k ; Quan-Yang Duh ; MD ; FACS^d ; Natalie Seiser ; MD ; PhD^d ; Carmen C. Solorzano ; MD ; FACS^l ; Colleen M. Kiernan ; MD^l ; Konstantinos I. Votanopoulos ; MD ; FACS^m ; Edward A. Levine ; MD ; FACS^m ; Charles A. Staley ; MD ; FACS^a ; George A. Poultsides ; MD ; FACS^b ; Shishir K. Maithel ; MD ; FACS^a ; ^{smaithe@emory.edu" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：222
• 期：4
• 页码：480-490
• 全文大小：641 K

文摘

Current treatment guidelines recommend adjuvant mitotane after resection of adrenocortical carcinoma with high-risk features (eg, tumor rupture, positive margins, positive lymph nodes, high grade, elevated mitotic index, and advanced stage). Limited data exist on the outcomes associated with these practice guidelines.

absSec_2">Study Design

abspara0015">Patients who underwent resection of adrenocortical carcinoma from 1993 to 2014 at the 13 academic institutions of the US Adrenocortical Carcinoma Group were included. Factors associated with mitotane administration were determined. Primary end points were recurrence-free survival (RFS) and overall survival (OS).

absSec_3">Results

abspara0020">Of 207 patients, 88 (43%) received adjuvant mitotane. Receipt of mitotane was associated with hormonal secretion (58% vs 32%; p = 0.001), advanced TNM stage (stage IV: 42% vs 23%; p = 0.021), adjuvant chemotherapy (37% vs 5%; p < 0.001), and adjuvant radiation (17% vs 5%; p = 0.01), but was not associated with tumor rupture, margin status, or N-stage. Median follow-up was 44 months. Adjuvant mitotane was associated with decreased RFS (10.0 vs 27.9 months; p = 0.007) and OS (31.7 vs 58.9 months; p = 0.006). On multivariable analysis, mitotane was not independently associated with RFS or OS, and margin status, advanced TNM stage, and receipt of chemotherapy were associated with survival. After excluding all patients who received chemotherapy, adjuvant mitotane remained associated with decreased RFS and similar OS; multivariable analyses again showed no association with recurrence or survival. Stage-specific analyses in both cohorts revealed no association between adjuvant mitotane and improved RFS or OS.

absSec_4">Conclusions

abspara0025">When accounting for stage and adverse tumor and treatment-related factors, adjuvant mitotane after resection of adrenocortical carcinoma is not associated with improved RFS or OS. Current guidelines should be revisited and prospective trials are needed.