|Authors||Tran TB, Maithel SK, Pawlik TM, Wang TS, Hatzaras I, Phay JE, Fields RC, Weber SM, Sicklick JK, Yopp AC, Duh QY, Solorzano CC, Votanopoulos KI, Poultsides GA|
|Journal||J. Am. Coll. Surg.|
|Publish Date||2016 Sep 9|
Adrenocortical carcinoma (ACC) is an aggressive malignancy typically resistant to chemotherapy and radiation. Surgery, even in the setting of locally recurrent or metastatic disease, remains the only potentially curative option. However, the subset of patients who will benefit from repeat resection in this setting remains ill defined. The objective of this study is to propose a prognostic clinical score that facilitates selection of patients for repeat resection of recurrent ACC.Patients who underwent curative-intent repeat resection for recurrent ACC at one of thirteen academic medical centers, participating in the United States ACC Study Group, were identified. Endpoints included morbidity, mortality, and overall survival.Fifty-six patients underwent repeat curative-intent resection for recurrent ACC (representing 21% of 265 patients who underwent resection for primary ACC) from 1997-2014. Median age was 52 years. Sites of resected recurrence included locoregional only (54%), lung only (14%), liver only (12%), combined locoregional and lung (4%), combined liver and lung (4%) and other distant sites (12%). Thirty-day morbidity and mortality rates were 40% and 5.4%, respectively. Cox regression analysis revealed that the presence of multifocal recurrence, disease free interval (DFI) <12 months, and extrapulmonary distant metastases were independent predictors of poor survival. A clinical score consisting of 1-point each for the above three variables demonstrated good discrimination in predicting survival after repeat resection (5-year: 72% for 0-points, 32% for 1 point, 0 % for 2 or 3 points, p=0.0006, AUC=0.78).Long-term survival after repeat resection for recurrent adrenocortical carcinoma is feasible when two of the following factors are present: solitary tumor, DFI >12months, and locoregional or pulmonary recurrence.