Adrenal Cortical Carcinoma: Retrospective analysis of 38 patients after surgical treatment
Aims: Adrenal cortical carcinomas (ACC) are rare endocrine neoplasm with poor prognosis. When diagnosed, ACCs are usually large and have invaded adjacent organs. Complete surgical resection remains the only potentially curative treatment for these patients. In this retrospective study we investigated the surgical outcome, disease free survival and overall survival of ACC patients treated at a single tertiary care hospital.
Methods: Retrospective analysis of 38 patients with ACC who underwent a primary resection from 1986 to 2008 in the surgery Department of the Heinrich Heine University and University Hospital Düsseldorf. Data on patient demographics, clinical symptoms, diagnostic course and disease stage, clinical and histological outcome were considered. Follow up data were collected to evaluate disease free survival and overall survival.
Results: 38 patients, median age of 45.5 ± 17.4 (range 5 – 75) underwent an adrenalectomy.
Recurrence free survival after complete resection (R0) was in median 10 month. Duration of the operation and hospital stay were significantly shorter in younger patients (< 46 year of age) and in patients with small tumors (UICC/WHO stages I and II versus III and IV). Metastases free survival was in median 9 month (n = 17, 95% Confidence Interval 0.933 – 17.067). In univariate and multivariate analyses male patients (p = 0.032/p = 0.017) and younger patients (< 46 years of age) (p = 0.035/p = 0.015) were presented with a significantly shorter metastases free survival. In univariate analysis gender, tumor size, tumor localisation and postoperative complication rate were significant prognostic factors. However, in multivariate analysis (Cox-Regression) only gender was a significant prognostic factor.
Conclusion: Our data suggest that male patients have a significant disadvantage in overall survival. Adjuvant mitotane may prolong median survival but the results are still disappointing. To avoid an imbalance in standardized treatment of patients with ACC these patients should be treated by an experienced multidisciplinary team in specialized endocrine centres.