Horm Metab Res 2019; 51(07): 451-457
DOI: 10.1055/a-0851-3275
Endocrine Care

Prognostic Factors of Malignant Pheochromocytoma and Paraganglioma: A Combined SEER and TCGA Databases Review

Lin Mei
1   Department of Hematology and Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
,
Arushi Khurana
1   Department of Hematology and Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
,
Taha Al-Juhaishi
1   Department of Hematology and Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
,
Anthony Faber
2   Philips Institute for Oral Health Research, Virginia Commonwealth University, Richmond, Virginia, USA
,
Francesco Celi
3   Department of Endocrinology and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA
,
Steven Smith
4   Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
,
Sosipatros Boikos
1   Department of Hematology and Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
› Author Affiliations

Abstract

Pheochromocytoma (PCC) and paraganglioma (PGL) are rare malignancies while pathogenesis is strongly influenced by genetics. The prognostic factors of these patients remain poorly defined. We aim to study the epidemiology and survival pattern by analyzing the combination of SEER and Cancer Genome Atlas (TCGA) database. Primary outcome was overall survival (OS) and disease specific survival (DSS). Between 1973 and 2013, a total of 1014 patients with PGL or PCC were analyzed. Younger age and female were associated with better outcomes. The incidence of second primary malignancy in PGL/PCC patients was about 14.6%. This population had a significant longer DSS. Other factors, including surgical resection and origin from of aortic/carotid bodies, conferred remarkable survival advantage. In contrast, distant spread portended worse prognosis. Laterality, race, positive serum catecholamine marker did not demonstrate a significant association with OS and DSS. By analyzing TCGA database with total 184 patients were identified. Eighty out of 184 patients (43.5%) had at least one pathogenic mutation. Female had higher ratio of pathogenic mutations than male (58.7% vs. 41.3%) and NF1 mutation was associated with elderly population. SHDB mutation had higher percentage in male. Twenty-nine patients (15.8%) had 2 or more primary. ATRX was the most common oncogenic mutations in metastatic cohort. In conclusion, younger age, female sex, origin from aortic/carotid bodies, complete surgical resection, regional disease, as well as concomitant second primary malignancies were associated with better prognosis. The prognostic value of radiotherapy and oncogenomics warrants further investigation.



Publication History

Received: 09 November 2018

Accepted: 31 January 2019

Article published online:
27 March 2019

Georg Thieme Verlag
Rüdigerstraße 14,70469 Stuttgart, Germany

 
  • References

  • 1 Dahia PL. Pheochromocytoma and paraganglioma pathogenesis: learning from genetic heterogeneity. Nat. Rev Cancer 2014; 14: 108-119
  • 2 Hamidi O, Young Jr. WF, Iniguez-Ariza NM. et al. Malignant Pheochromocytoma and Paraganglioma: 272 Patients Over 55 Years. J Clin Endocrinol Metab 2017; 102: 3296-3305
  • 3 Chen H, Sippel RS, O'Dorisio MS. et al. The North American Neuroendocrine Tumor Society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas 2010; 39: 775-783
  • 4 Crona J, Taieb D, Pacak K. New perspectives on pheochromocytoma and paraganglioma: toward a molecular classification. Endocr Rev 2017; 38: 489-515
  • 5 Fishbein L, Leshchiner I, Walter V. et al. Comprehensive molecular characterization of pheochromocytoma and paraganglioma. Cancer Cell 2017; 31: 181-193
  • 6 Goffredo P, Sosa JA, Roman SA. Malignant pheochromocytoma and paraganglioma: a population level analysis of long-term survival over two decades. J Surg Oncol 2013; 107: 659-664
  • 7 Purnell S, Sidana A, Maruf M. et al. Genitourinary paraganglioma: Demographic, pathologic, and clinical characteristics in the surveillance, epidemiology, and end results database (2000-2012). Urol Oncol 2017; 35: 457 e459-457 e414
  • 8 Sethi RV, Sethi RK, Herr MW. et al. Malignant head and neck paragangliomas: treatment efficacy and prognostic indicators. Am J Otolaryngol 2013; 34: 431-438
  • 9 Schovanek J, Martucci V, Wesley R. et al. The size of the primary tumor and age at initial diagnosis are independent predictors of the metastatic behavior and survival of patients with SDHB-related pheochromocytoma and paraganglioma: a retrospective cohort study. BMC Cancer 2014; 14: 523
  • 10 Nockel P, El Lakis M, Gaitanidis A. et al. Preoperative genetic testing in pheochromocytomas and paragangliomas influences the surgical approach and the extent of adrenal surgery. Surgery 2018; 163: 191-196
  • 11 Turkova H, Prodanov T, Maly M. et al. Characteristics and outcomes of metastatic SDHB and sporadic pheochromocytoma/paraganglioma: A National Institute of health study. Endocr Pract 2016; 22: 302-314
  • 12 Jochmanova I, Wolf KI, King KS. et al. SDHB-related pheochromocytoma and paraganglioma penetrance and genotype-phenotype correlations. J Cancer Res Clin Oncol 2017; 143: 1421-1435
  • 13 DeSantis CE, Siegel RL, Sauer AG. et al. Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities. CA Cancer J Clin 2016; 66: 290-308
  • 14 Hamidi O, Young Jr. WF, Gruber L. et al. Outcomes of patients with metastatic phaeochromocytoma and paraganglioma: A systematic review and meta-analysis. Clin Endocrinol 2017; 87: 440-450
  • 15 Kavinga Gunawardane PT, Grossman A. The clinical genetics of phaeochromocytoma and paraganglioma. Arch Endocrinol Metab 2017; 61: 490-500
  • 16 Turchini J, Cheung VKY, Tischler AS. et al. Pathology and genetics of phaeochromocytoma and paraganglioma. Histopathology 2018; 72: 97-105
  • 17 Eisenhofer G, Timmers HJ, Lenders JW. et al. Age at diagnosis of pheochromocytoma differs according to catecholamine phenotype and tumor location. J Clin Endocrinol Metab 2011; 96: 375-384
  • 18 Dahia PL. Pheochromocytomas and paragangliomas, genetically diverse and minimalist, all at once!. Cancer Cell 2017; 31: 159-161
  • 19 Suh YJ, Choe JY, Park HJ. Malignancy in pheochromocytoma or paraganglioma: integrative analysis of 176 cases in tcga. Endocrine pathology 2017; 28: 159-164
  • 20 Chapman DB, Lippert D, Geer CP. et al. Clinical, histopathologic, and radiographic indicators of malignancy in head and neck paragangliomas. Otolaryngol Head Neck Surg 2010; 143: 531-537
  • 21 Manolidis S, Shohet JA, Jackson CG. et al. Malignant glomus tumors. Laryngoscope 1999; 109: 30-34
  • 22 Neumann HP, Pawlu C, Peczkowska M. et al. Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations. JAMA 2004; 292: 943-951
  • 23 Lee JH, Barich F, Karnell LH. et al. National Cancer Data Base report on malignant paragangliomas of the head and neck. Cancer 2002; 94: 730-737