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Outcomes after resection of cortisol-secreting adrenocortical carcinoma. 2016
Georgios Antonios Margonis, and
Yuhree Kim, and
Thuy B Tran, and
Lauren M Postlewait, and
Shishir K Maithel, and
Tracy S Wang, and
Jason A Glenn, and
Ioannis Hatzaras, and
Rivfka Shenoy, and
John E Phay, and
Kara Keplinger, and
Ryan C Fields, and
Linda X Jin, and
Sharon M Weber, and
Ahmed Salem, and
Jason K Sicklick, and
Shady Gad, and
Adam C Yopp, and
John C Mansour, and
Quan-Yang Duh, and
Natalie Seiser, and
Carmen C Solorzano, and
Colleen M Kiernan, and
Konstantinos I Votanopoulos, and
Edward A Levine, and
George A Poultsides, and
Timothy M Pawlik
Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
BACKGROUND We sought to define the impact of cortisol-secreting status on outcomes after surgical resection of adrenocortical carcinoma (ACC). METHODS The U.S ACC group database was queried to identify patients who underwent ACC resection between 1993 and 2014. The short-term and long-term outcomes were assessed. RESULTS The incidence of all functional and cortisol-secreting tumors was 40.6% and 22.6%, respectively. On multivariable analysis, cortisol secretion remained associated with an increased risk of postoperative complications (odds ratio = 2.25, 95 % confidence interval = 1.04 to 4.88; P = .04). At a median follow-up of 17.6Â months, 118 patients (50.4%) had developed a recurrence. On multivariable analysis, after adjusting for patient and disease-related factors cortisol secretion independently predicted shorter recurrence-free survival (Hazard ratio = 2.05, 95% confidence interval = 1.16 to 3.60; P = .01). CONCLUSIONS Cortisol secretion was associated with an increased risk of postoperative morbidity. Recurrence remains high among patients with ACC after surgery; cortisol secretion was independently associated with a shorter recurrence-free survival. Tailoring postoperative surveillance of ACC patients based on their cortisol secreting status may be important.
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