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Zuber SM, Kuchta K, Holoubek SA, Khokar A, Moo-Young T, Prinz RA, Winchester DJ. Validated predictive model for treatment and prognosis of adrenocortical carcinoma. Surgery 2024; 175:743-751. [PMID: 37953139 DOI: 10.1016/j.surg.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Adrenocortical carcinoma has a poor prognosis and multiple clinical, pathological, and treatment variables. Currently, we lack a prognostic and treatment calculator to determine the survival and efficacy of adjuvant chemoradiation. We aimed to validate a calculator to assess prognosis and treatment. METHODS We searched the National Cancer Database to identify patients with adrenocortical carcinoma surgically treated from 2004 to 2020 and randomly allocated them into a training (80%) or validation set (20%). We analyzed the variables of age; sex; Charlson Comorbidity Index; insurance status; tumor size; pathologic tumor, node, and metastasis categories; surgical margins; and use of chemotherapy and radiation therapy. We used Cox regression prediction models and bootstrap coefficients to generate a mathematical model to predict 5- and 10-year overall survival. After using the area under the curve analysis to assess the model's performance, we compared overall survival in the training and validation sets. RESULTS Multivariable analysis of the 3,480 patients included in the study revealed that all variables were significant except sex (P < .05) and incorporated into a mathematical model. The area under the curve for 5- and 10-year overall survival was 0.68 and 0.70, respectively, for the training set and 0.70 and 0.72, respectively, for the validation set. For the bootstrap coefficients, the 5- and 10-year overall survival was 6.4% and 4.1%, respectively, above the observed mean. CONCLUSION Our model predicts the overall survival of patients with adrenocortical carcinoma based on clinical, pathologic, and treatment variables and can assist in individualizing treatment.
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Affiliation(s)
- Samuel M Zuber
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, University of Chicago Medicine, Chicago, IL.
| | - Kristine Kuchta
- Bioinformatics and Research Core, NorthShore University Health Evanston, IL
| | - Simon A Holoubek
- Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Amna Khokar
- Department of Surgery, John H. Stroger Jr. Cook County Hospital, Chicago, IL
| | - Tricia Moo-Young
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Richard A Prinz
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, University of Chicago Medicine, Chicago, IL
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2
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Kimpel O, Altieri B, Laganà M, Vogl TJ, Adwan H, Dusek T, Basile V, Pittaway J, Dischinger U, Quinkler M, Kroiss M, Puglisi S, Cosentini D, Kickuth R, Kastelan D, Fassnacht M. The Value of Local Therapies in Advanced Adrenocortical Carcinoma. Cancers (Basel) 2024; 16:706. [PMID: 38398097 PMCID: PMC10886520 DOI: 10.3390/cancers16040706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
International guidelines recommend local therapies (LTs) such as local thermal ablation (LTA; radiofrequency, microwave, cryoablation), transarterial (chemo)embolisation (TA(C)E), and transarterial radioembolisation (TARE) as therapeutic options for advanced adrenocortical carcinoma (ACC). However, the evidence for these recommendations is scarce. We retrospectively analysed patients receiving LTs for advanced ACC. Time to progression of the treated lesion (tTTP) was the primary endpoint. The secondary endpoints were best objective response, overall progression-free survival, overall survival, adverse events, and the establishment of predictive factors by multivariate Cox analyses. A total of 132 tumoural lesions in 66 patients were treated with LTA (n = 84), TA(C)E (n = 40), and TARE (n = 8). Complete response was achieved in 27 lesions (20.5%; all of them achieved by LTA), partial response in 27 (20.5%), and stable disease in 38 (28.8%). For the LTA group, the median tTTP was not reached, whereas it was reached 8.3 months after TA(C)E and 8.2 months after TARE (p < 0.001). The median time interval from primary diagnosis to LT was >47 months. Fewer than four prior therapies and mitotane plasma levels of >14 mg/L positively influenced the tTTP. In summary, this is one of the largest studies on LTs in advanced ACC, and it demonstrates a very high local disease control rate. Thus, it clearly supports the guideline recommendations for LTs in these patients.
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Affiliation(s)
- Otilia Kimpel
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, 97070 Würzburg, Germany; (B.A.); (U.D.); (M.K.); (M.F.)
| | - Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, 97070 Würzburg, Germany; (B.A.); (U.D.); (M.K.); (M.F.)
| | - Marta Laganà
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (M.L.); (D.C.)
| | - Thomas J. Vogl
- Universitätsklinikum Frankfurt, Institut für Diagnostische und Interventionelle Radiologie, 60596 Frankfurt, Germany; (T.J.V.)
| | - Hamzah Adwan
- Universitätsklinikum Frankfurt, Institut für Diagnostische und Interventionelle Radiologie, 60596 Frankfurt, Germany; (T.J.V.)
| | - Tina Dusek
- Department of Endocrinology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (T.D.); (D.K.)
| | - Vittoria Basile
- Internal Medicine 1, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (V.B.); (S.P.)
| | - James Pittaway
- Department of Endocrinology, St Bartholomew’s Hospital, London EC1A 7BE, UK;
| | - Ulrich Dischinger
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, 97070 Würzburg, Germany; (B.A.); (U.D.); (M.K.); (M.F.)
| | | | - Matthias Kroiss
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, 97070 Würzburg, Germany; (B.A.); (U.D.); (M.K.); (M.F.)
- Department of Medicine IV, University Hospital, LMU Munich, Ziemssenstraße 1, 80336 München, Germany
| | - Soraya Puglisi
- Internal Medicine 1, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (V.B.); (S.P.)
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (M.L.); (D.C.)
| | - Ralph Kickuth
- Institute of Diagnostic and Interventional Radiology, University-Hospital of Würzburg, 97080 Würzburg, Germany;
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (T.D.); (D.K.)
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, 97070 Würzburg, Germany; (B.A.); (U.D.); (M.K.); (M.F.)
- Comprehensive Cancer Center Mainfranken, University of Würzburg, 97070 Würzburg, Germany
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3
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Wu L, Chen J, Su T, Jiang L, Han Y, Zhang C, Zhou W, Jiang Y, Zhong X, Wang W. Efficacy and safety of adjuvant radiation therapy in localized adrenocortical carcinoma. Front Endocrinol (Lausanne) 2024; 14:1308231. [PMID: 38260140 PMCID: PMC10801189 DOI: 10.3389/fendo.2023.1308231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Context Adrenocortical carcinoma (ACC) is rare and have high rates of recurrence and mortality. The role of adjuvant radiation therapy (RT) in localized ACC was controversial. Methods We conducted a retrospective study in our center between 2015 and 2021 to evaluate the efficacy and safety of adjuvant RT in localized ACC. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to estimate the independent risk factors. Adverse events associated with RT were documented according to the toxicity criteria of the radiation therapy oncology group (RTOG) and the common terminology criteria for adverse events (CTCAE v5.0). Results Of 105 patients with localized ACC, 46 (43.8%) received adjuvant RT after surgery. The median radiation dose was 45.0Gy (range:30.0-50.4) and median follow up time was 36.5 (IQR: 19.7-51.8) months. In comparison to the no adjuvant RT group, patients with adjuvant RT had better 3-year OS (87.9% vs 79.5%, P=0.039), especially for patients with ENSAT I/II stage (P=0.004). Adjuvant RT also improved the median DFS time from 16.5months (95%CI, 12.0-20.9) to 34.6months (95%CI, 16.1-53.0). Toxicity of RT was generally mild and moderate with six grade 3 events. Conclusions Postoperative adjuvant RT significantly improved OS and DFS compared with the use of surgery alone in resected ACC patients. Although this retrospective study on RT in localized ACC indicates that RT is effective in ACC, its findings need to be prospectively confirmed.
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Affiliation(s)
- Luming Wu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingwei Su
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Jiang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yimin Han
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cui Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhou
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiran Jiang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu Zhong
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Schwarzlmueller P, Corradini S, Seidensticker M, Zimmermann P, Schreiner J, Maier T, Triebig A, Knösel T, Pazos M, Pfluger T, Weigand I, Belka C, Ricke J, Reincke M, Schmidmaier R, Kroiss M. High-Dose Rate Brachytherapy Combined with PD-1 Blockade as a Treatment for Metastatic Adrenocortical Carcinoma - A Single Center Case Series. Horm Metab Res 2024; 56:30-37. [PMID: 37748508 DOI: 10.1055/a-2150-3944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The response rate of advanced adrenocortical carcinoma (ACC) to standard chemotherapy with mitotane and etoposide/doxorubicin/cisplatin (EDP-M) is unsatisfactory, and benefit is frequently short lived. Immune checkpoint inhibitors (CPI) have been examined in patient's refractory to EDP-M, but objective response rates are only approximately 15%. High-dose rate brachytherapy (HDR-BT) is a catheter-based internal radiotherapy and expected to favorably combine with immunotherapies. Here we describe three cases of patients with advanced ACC who were treated with HDR-BT and the CPI pembrolizumab. None of the tumors were positive for established response markers to CPI. All patients were female, had progressed on EDP-M and received external beam radiation therapy for metastatic ACC. Pembrolizumab was initiated 7 or 23 months after brachytherapy in two cases and prior to brachytherapy in one case. Best response of lesions treated with brachytherapy was complete (n=2) or partial response (n=1) that was ongoing at last follow up after 23, 45 and 4 months, respectively. Considering all sites of tumor, response was complete and partial remission in the two patients with brachytherapy prior to pembrolizumab. The third patient developed progressive disease with severe Cushing's syndrome and died due to COVID-19. Immune-related adverse events of colitis (grade 3), gastroduodenitis (grade 3), pneumonitis (grade 2) and thyroiditis (grade 1) occurred in the two patients with systemic response. HDR-BT controlled metastases locally. Sequential combination with CPI therapy may enhance an abscopal antitumoral effect in non-irradiated metastases in ACC. Systematic studies are required to confirm this preliminary experience and to understand underlying mechanisms.
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Affiliation(s)
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Petra Zimmermann
- Department of General, Visceral and Transplant Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Jochen Schreiner
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Tanja Maier
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Alexandra Triebig
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Pfluger
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Isabel Weigand
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Reincke
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Ralf Schmidmaier
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Kroiss
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
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5
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Kimpel O, Dischinger U, Altieri B, Fuss CT, Polat B, Kickuth R, Kroiss M, Fassnacht M. Current Evidence on Local Therapies in Advanced Adrenocortical Carcinoma. Horm Metab Res 2024; 56:91-98. [PMID: 38171374 PMCID: PMC10764152 DOI: 10.1055/a-2209-6022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/25/2023] [Indexed: 01/05/2024]
Abstract
International guidelines emphasise the role of local therapies (LT) for the treatment of advanced adrenocortical carcinoma (ACC). However, large studies are lacking in this field. Therefore, we performed a review of the literature to synthesise current evidence and develop clinical guidance. PubMed database was searched for systematic literature. We identified 119 potentially relevant articles, of which 21 could be included in our final analysis. All were retrospective and reported on 374 patients treated with LT for advanced ACC (12 studies on radiotherapy, 3 on transarterial chemoembolisation and radioembolisation, 4 on image-guided thermal ablation [radiofrequency, microwave ablation, and cryoablation, and two studies reporting treatment with several different LT]). Radiotherapy was frequently performed with palliative intention. However, in most patients, disease control and with higher dosage also partial responses could be achieved. Data for other LT were more limited, but also point towards local disease control in a significant percentage of patients. Very few studies tried to identify factors that are predictive on response. Patients with a disease-free interval after primary surgery of more than 9 months and lesions<5 cm might benefit most. Underreporting of toxicities may be prevalent, but LT appear to be relatively safe overall. Available evidence on LT for ACC is limited. LT appears to be safe and effective in cases with limited disease and should be considered depending on local expertise in a multidisciplinary team discussion.
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Affiliation(s)
- Otilia Kimpel
- Division of Endocrinology and Diabetes, Department of Medicine,
University Hospital, University of Würzburg, Würzburg,
Germany
| | - Ulrich Dischinger
- Division of Endocrinology and Diabetes, Department of Medicine,
University Hospital, University of Würzburg, Würzburg,
Germany
| | - Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Medicine,
University Hospital, University of Würzburg, Würzburg,
Germany
| | - Carmina Teresa Fuss
- Division of Endocrinology and Diabetes, Department of Medicine,
University Hospital, University of Würzburg, Würzburg,
Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital, University of
Würzburg, Würzburg, Germany
| | - Ralph Kickuth
- Institute of Diagnostic and Interventional Radiology, University
Hospital, University of Würzburg, Würzburg,
Germany
| | - Matthias Kroiss
- Division of Endocrinology and Diabetes, Department of Medicine,
University Hospital, University of Würzburg, Würzburg,
Germany
- Department of Internal Medicine IV, University Hospital,
Ludwig-Maximilians-Universität München, München,
Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Medicine,
University Hospital, University of Würzburg, Würzburg,
Germany
- Comprehensive Cancer Center Mainfranken, University of
Würzburg, Würzburg, Germany
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6
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Michalski K, Schlötelburg W, Hartrampf PE, Kosmala A, Buck AK, Hahner S, Schirbel A. Radiopharmaceuticals for Treatment of Adrenocortical Carcinoma. Pharmaceuticals (Basel) 2023; 17:25. [PMID: 38256859 PMCID: PMC10820941 DOI: 10.3390/ph17010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Adrenocortical carcinoma (ACC) represents a rare tumor entity with limited treatment options and usually rapid tumor progression in case of metastatic disease. As further treatment options are needed and ACC metastases are sensitive to external beam radiation, novel theranostic approaches could complement established therapeutic concepts. Recent developments focus on targeting adrenal cortex-specific enzymes like the theranostic twin [123/131I]IMAZA that shows a good image quality and a promising therapeutic effect in selected patients. But other established molecular targets in nuclear medicine such as the C-X-C motif chemokine receptor 4 (CXCR4) could possibly enhance the therapeutic regimen as well in a subgroup of patients. The aims of this review are to give an overview of innovative radiopharmaceuticals for the treatment of ACC and to present the different molecular targets, as well as to show future perspectives for further developments since a radiopharmaceutical with a broad application range is still warranted.
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Affiliation(s)
- Kerstin Michalski
- Department of Nuclear Medicine, Würzburg University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany (A.K.B.); (A.S.)
| | - Wiebke Schlötelburg
- Department of Nuclear Medicine, Würzburg University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany (A.K.B.); (A.S.)
| | - Philipp E. Hartrampf
- Department of Nuclear Medicine, Würzburg University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany (A.K.B.); (A.S.)
| | - Aleksander Kosmala
- Department of Nuclear Medicine, Würzburg University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany (A.K.B.); (A.S.)
| | - Andreas K. Buck
- Department of Nuclear Medicine, Würzburg University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany (A.K.B.); (A.S.)
| | - Stefanie Hahner
- Division of Endocrinology and Diabetes, Department of Medicine I, Würzburg University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany;
| | - Andreas Schirbel
- Department of Nuclear Medicine, Würzburg University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany (A.K.B.); (A.S.)
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7
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Libé R, Huillard O. Adrenocortical carcinoma: Diagnosis, prognostic classification and treatment of localized and advanced disease. Cancer Treat Res Commun 2023; 37:100759. [PMID: 37690343 DOI: 10.1016/j.ctarc.2023.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare cancer with an estimated incidence of 0.7 to 2.0 cases per 1 million population per year in the United States. It is an aggressive cancer originating in the cortex of the adrenal gland with a poor prognosis. The 5-year survival rate is less than 15% among patients with metastatic disease. In this article, we review the epidemiology and pathogenesis of ACC, the diagnostic procedures, the prognostic classification of ACC, and the treatment options from localized and resectable forms to advanced disease detailing recent therapeutic developments such as immunotherapy and molecularly targeted therapy.
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Affiliation(s)
- Rossella Libé
- Service Endocrinologie, AP-HP, Hôpital Cochin, French National Network, ENDOCAN-COMETE, F-75014, Paris, France
| | - Olivier Huillard
- Institut du Cancer Paris CARPEM, AP-HP, Department of medical oncology, Hôpital Cochin, F-75014, Paris, France.
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8
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Libé R, Haissaguerre M, Renaudin K, Faron M, Decaussin-Petrucci M, Deschamps F, Gimenez-Roqueplo AP, Mirallie E, Murez T, Pattou F, Rocher L, Taïeb D, Savoie PH, Tabarin A, Bertherat J, Baudin E, de la Fouchardière C. [Guidelines of the French National ENDOCAN-COMETE, Association of Endocrine Surgery, Society of Urology for the management of adrenocortical carcinoma]. Bull Cancer 2023; 110:707-730. [PMID: 37061367 DOI: 10.1016/j.bulcan.2023.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/17/2023]
Abstract
The adrenocortical carcinoma (ACC) is a primary malignant tumor developed from the adrenal cortex, defined by a Weiss score≥3. Its prognosis is poor and depends mainly on the stage of the disease at diagnosis. Care is organized in France by the multidisciplinary expert centers of the national ENDOCAN-COMETE "Adrenal Cancers" network, certified by the National Cancer Institute. This document updates the guidelines for the management of ACC in adults based on the most robust data in the literature. It's divided into 11 chapters: (1) circumstances of discovery; (2) pre-therapeutic assessment; (3) diagnosis of ACC; (4) oncogenetics; (5) prognostic classifications; (6) treatment of hormonal hypersecretion; (7) treatment of localized forms; (8) treatment of relapses; (9) treatment of advanced forms; (10) follow-up; (11) the particular case of ACC and pregnancy. R0 resection of all localized ACC remains an unmet need and it must be performed in expert centers. Flow-charts for the therapeutic management of localized ACC, relapse or advanced ACC are provided. It was written by the experts from the national ENDOCAN-COMETE network and validated by all French Societies involved in the management of these patients (endocrinology, medical oncology, endocrine surgery, urology, pathology, genetics, nuclear medicine, radiology, interventional radiology).
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Affiliation(s)
- Rossella Libé
- CHU Paris Centre, hôpital Cochin, centre coordonnateur ENDOCAN-COMETE, service d'endocrinologie, Paris, France.
| | - Magalie Haissaguerre
- CHU de Bordeaux, hôpital Haut-Lévêque, centre coordonnateur ENDOCAN-COMETE, service d'endocrinologie, Pessac, France
| | - Karine Renaudin
- CHU de Nantes, hôpital Hôtel-Dieu, service d'anatomie pathologique, Nantes, France
| | - Matthieu Faron
- Gustave-Roussy Cancer Campus, service de chirurgie viscérale oncologique, Villejuif, France
| | | | - Fréderic Deschamps
- Gustave-Roussy Cancer Campus, département de radiologie interventionnelle, Villejuif, France
| | | | - Eric Mirallie
- CHU de Nantes, hôpital Hôtel-Dieu, institut des maladies de l'appareil digestif, chirurgie cancérologique, digestive et endocrinienne, Nantes, France
| | - Thibaut Murez
- CHU de Montpellier, département d'urologie et transplantation rénale, Montpellier, France
| | - François Pattou
- CHRU de Lille, département de chirurgie endocrinienne et métabolique, Lille, France
| | - Laurence Rocher
- Hôpitaux et université Paris Saclay, hôpital Antoine-Béclère, service de radiologie, Clamart, France
| | - David Taïeb
- La Timone University Hospital, Aix-Marseille University, CERIMED, département de médecine nucléaire, Marseille, France
| | - Pierre Henri Savoie
- Hôpital d'instruction des Armées Sainte-Anne, service d'urologie, Toulon, France
| | - Antoine Tabarin
- CHU de Bordeaux, hôpital Haut-Lévêque, centre coordonnateur ENDOCAN-COMETE, service d'endocrinologie, Pessac, France
| | - Jérôme Bertherat
- CHU Paris Centre, hôpital Cochin, centre coordonnateur ENDOCAN-COMETE, service d'endocrinologie, Paris, France
| | - Eric Baudin
- Gustave-Roussy Cancer Campus, centre coordonnateur ENDOCAN-COMETE, service de cancérologie endocrine, Villejuif, France
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Khosla D, Kapoor R, Singla AK, Periasamy K, Goyal S, Madan R, Kumar N, Behera A, Singh SK, Bhadada SK, Walia R. Treatment outcomes of adjuvant radiotherapy in adrenocortical carcinoma - A 13-years experience from a tertiary care centre. Rare Tumors 2023; 15:20363613231160699. [PMID: 36860827 PMCID: PMC9969472 DOI: 10.1177/20363613231160699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Purpose Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignant neoplasm, usually diagnosed in advanced stage. Role and efficacy of adjuvant radiotherapy has not been well defined. The objective of this study is to describe the various clinical characteristics and prognostic factors affecting the survival of ACC along with the role radiotherapy on overall survival and relapse free survival. Methods A retrospective analysis of 30 patients registered between 2007 and 2019 was carried out. The medical records containing clinical and treatment details were analysed. Data was analysed using SPSS 25.0. Survival curves were computed using Kaplan-Meier method. Univariate and multivariate analyses were performed to analyze the prognostic factors affecting the outcome. A p value of less than 0.05 was considered to be statistically significant. Results The median age of patients was 37.5 years (range, 5-72 years). 20 patients were females. Twenty-six patients had advanced stage (III/IV) disease while only four patients presented in early stage. Twenty-six patients underwent total adrenalectomy. Eighty three percent patients received adjuvant radiation therapy. The median follow up was 35.5 months (range, 7 monthss-132months). The estimated three- and 5-years overall survival (OS) was 67.2% and 23.3%, respectively. Capsular invasion and positive margins were the independent prognostic factors influencing both OS and relapse free survival (RFS). Out of 25 patients who received adjuvant radiation, only three patients had local relapse. Conclusion ACC is a rare and aggressive neoplasm with majority of patients presenting in advanced stage. Surgical resection with negative margins remains the mainstay of treatment. Capsular invasion and positive margins are independent prognostic factors for survival. Adjuvant radiation reduces the risk of local relapse and is well tolerated. Radiation can be used effectively in adjuvant and palliative settings in ACC.
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Affiliation(s)
- Divya Khosla
- Department of Radiotherapy and
Oncology, Regional Cancer Centre, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and
Oncology, Regional Cancer Centre, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Aditya K Singla
- Department of Radiotherapy and
Oncology, Regional Cancer Centre, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India,Aditya K Singla, Department of Radiotherapy
and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER),
Regional Cancer Centre, Chandigarh, India. E-mail:
| | - Kannan Periasamy
- Department of Radiotherapy and
Oncology, Regional Cancer Centre, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and
Oncology, Regional Cancer Centre, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and
Oncology, Regional Cancer Centre, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy and
Oncology, Regional Cancer Centre, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Arunanshu Behera
- Department of General Surgery, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Sanjay K Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
| | - Rama Walia
- Department of Endocrinology, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
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10
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Kimpel O, Schindler P, Schmidt-Pennington L, Altieri B, Megerle F, Haak H, Pittaway J, Dischinger U, Quinkler M, Mai K, Kroiss M, Polat B, Fassnacht M. Efficacy and safety of radiation therapy in advanced adrenocortical carcinoma. Br J Cancer 2023; 128:586-593. [PMID: 36482186 PMCID: PMC9938283 DOI: 10.1038/s41416-022-02082-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND International guidelines emphasise the role of radiotherapy (RT) for the management of advanced adrenocortical carcinoma (ACC). However, the evidence for this recommendation is very low. METHODS We retrospectively analysed all patients who received RT for advanced ACC in five European centres since 2000. PRIMARY ENDPOINT time to progression of the treated lesion (tTTP). Secondary endpoints: best objective response, progression-free survival (PFS), overall survival (OS), adverse events, and the establishment of predictive factors by Cox analyses. RESULTS In total, 132 tumoural lesions of 80 patients were treated with conventional RT (cRT) of 50-60 Gy (n = 20) or 20-49 Gy (n = 69), stereotactic body RT of 35-50 Gy (SBRT) (n = 36), or brachytherapy of 12-25 Gy (BT) (n = 7). Best objective lesional response was complete (n = 6), partial (n = 52), stable disease (n = 60), progressive disease (n = 14). Median tTTP was 7.6 months (1.0-148.6). In comparison to cRT20-49Gy, tTTP was significantly longer for cRT50-60Gy (multivariate adjusted HR 0.10; 95% CI 0.03-0.33; p < 0.001) and SBRT (HR 0.31; 95% CI 0.12-0.80; p = 0.016), but not for BT (HR 0.66; 95% CI 0.22-1.99; p = 0.46). Toxicity was generally mild and moderate with three grade 3 events. No convincing predictive factors could be established. CONCLUSIONS This largest published study on RT in advanced ACC provides clear evidence that RT is effective in ACC.
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Affiliation(s)
- Otilia Kimpel
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Paul Schindler
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Laura Schmidt-Pennington
- Department of Endocrinology & Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Megerle
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Harm Haak
- Department of Internal Medicine, Máxima MC, Eindhoven/Veldhoven The Netherlands. Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands. Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - James Pittaway
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ulrich Dischinger
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Marcus Quinkler
- Department of Endocrinology & Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
- Endocrinology in Charlottenburg, Berlin, Germany
| | - Knut Mai
- Department of Endocrinology & Metabolism, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Matthias Kroiss
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, Würzburg, Germany
- Department of Medicine IV, University Hospital, LMU Munich, Ziemssenstraße 1, 80336, München, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, University of Würzburg, Würzburg, Germany.
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.
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11
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Kijima T, Fukuda S, Fukushima H, Uehara S, Yasuda Y, Yoshida S, Yokoyama M, Matsuoka Y, Saito K, Fujii Y. The role of multimodal salvage therapy in the management of recurrent adrenocortical carcinoma. Jpn J Clin Oncol 2023; 53:436-442. [PMID: 36629278 DOI: 10.1093/jjco/hyac207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Adrenocortical carcinoma is an aggressive tumor which often recurs despite apparent complete resection. This study assessed the long-term outcomes for patients with recurrent adrenocortical carcinoma after multimodal salvage therapy with chemotherapy, chemoradiotherapy and surgery. METHODS We retrospectively reviewed medical records of patients who had a pathological diagnosis of adrenocortical carcinoma between 1996 and 2017. Kaplan-Meier curves were used to assess progression-free and cancer-specific survivals among all patients and cancer-specific survival among patients with tumor recurrence. Log-rank test was used to compare patient survivals by modality of salvage therapy (chemotherapy, chemoradiotherapy and chemotherapy/chemoradiotherapy plus surgery). RESULTS Of 20 patients who underwent initial surgery, recurrence occurred in 14 (70%) with a median interval of 7.5 (range 1.0-12.6) months. Salvage therapy provided was chemotherapy only (n = 7), chemoradiotherapy (n = 2) and chemotherapy/chemoradiotherapy plus surgery (n = 5). Of the five patients who received salvage surgery, three underwent repeated resections. The potential benefit of multimodal salvage therapy was suggested in five patients (4 with chemotherapy/chemoradiotherapy plus surgery and 1 with chemoradiotherapy) who achieved durable disease control (cancer-specific survival from initial recurrence, 22-258 months). With a median follow-up of 25 months from recurrence, the 5-year cancer-specific survival rate was 58%. cancer-specific survival after recurrence was prolonged in patients with ≤ stage 3 disease, positive response to chemotherapy/chemoradiotherapy and salvage surgery. CONCLUSIONS Long-term disease control and survival could be achieved in highly selected patients with recurrent adrenocortical carcinoma using a multidisciplinary approach. Patients who had relatively limited recurrent sites and responded well to chemotherapy/chemoradiotherapy may be considered for salvage surgery on a case-by-case basis.
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Affiliation(s)
- Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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12
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He S, Huang X, Zhao P, Zhang P. The prognosis difference between elderly and younger patients with adrenocortical carcinoma. Front Genet 2023; 13:1029155. [PMID: 36685908 PMCID: PMC9845245 DOI: 10.3389/fgene.2022.1029155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Background and aim: Adrenocortical carcinoma (ACC) is uncommon in the elderly. This study aimed to compare the surgical prognosis and survival between senior and younger patients. We also explored the factors that were independently related to the survival of elderly patients. Methods: We identified ACC patients between 2010 and 2019 in the Surveillance, Epidemiology, and End Results (SEER) database and applied Kaplan-Meier curves to evaluate the overall survival (OS) and cancer-specific survival (CSS) with log-rank tests. We also used Cox regression analysis to estimate the OS and CSS. The Fine and Gray model with the Gray test was used to measure the cumulative incidence function (CIF) of CSS and other mortality causes of patients in a competing-risks setting. Results: Of 876 patients, 44.06% were elderly. A lower proportion of elderly patients underwent surgery, regional lymph node surgery, and chemotherapy than young patients. Elderly patients also had inferior OS and CSS than younger patients. The 1- and 5-year OS of elderly patients who underwent surgery were 68% [95% confidence interval (CI): 62%-74%] and 30% (95% CI: 24%-38%), and the 1- and 5-year CSS were 73% (95% CI: 67%-80%) and 40% (95% CI: 32%-47%). The factors independently related to worsened survival included age ≥60 [Hazard Ratio (HR): 1.47 (1.24-1.75)], metastatic disease [HR: 1.90 (1.49-2.51)], higher grade [HR: 1.94 (1.08-3.46)] and Network for the Study of Adrenal Tumors (ENSAT) stage [HR: 1.99 (1.48-2.66)]. Conclusion: Younger ACC patients had better survival than the elderly. Factors independently related to worsened survival in elderly patients included age ≥60, metastatic disease, higher grade, and European ENSAT stage.
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Affiliation(s)
- Shengyin He
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Institute of Urology, Sichuan University, Chengdu, Sichuan, China
| | - Xuemei Huang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, Sichuan, China
| | - Pan Zhao
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, Sichuan, China
| | - Peng Zhang
- The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, Sichuan, China,*Correspondence: Peng Zhang,
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13
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Kimball A, Sertic M, Saylor PJ, Kamran SC, Boyraz B. Case 38-2022: A 21-Year-Old Woman with Fatigue and Weight Gain. N Engl J Med 2022; 387:2269-2277. [PMID: 36516093 DOI: 10.1056/nejmcpc2201250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Allison Kimball
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
| | - Madeleine Sertic
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
| | - Philip J Saylor
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
| | - Sophia C Kamran
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
| | - Baris Boyraz
- From the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Massachusetts General Hospital, and the Departments of Medicine (A.K., P.J.S.), Radiology (M.S.), Radiation Oncology (S.C.K.), and Pathology (B.B.), Harvard Medical School - both in Boston
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14
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Chihara I, Nagumo Y, Kandori S, Kojo K, Sano K, Hamada K, Tanuma K, Tsuchiya H, Shiga M, Sakka S, Kimura T, Kawahara T, Hoshi A, Negoro H, Kojima T, Bryan MJ, Okuyama A, Higashi T, Nishiyama H. Clinicopathological features of adrenal malignancies: Analysis of hospital-based cancer registry data in Japan. Int J Urol 2022; 29:1331-1337. [PMID: 35976672 DOI: 10.1111/iju.14996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 07/04/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify the clinicopathological features of adrenal malignancies and analyze the prognoses of patients with adrenal cortical carcinoma (ACC) and malignant pheochromocytoma (MPCC). PATIENTS AND METHODS We used a hospital-based cancer registry data in Japan to extract cases of adrenal malignancies that were histologically confirmed, diagnosed, and initially treated from 2012-2015. For survival analysis, we used data from the 2008-2009 cohort to estimate 5-year overall survival (OS) by the Kaplan-Meier method. RESULTS A total of 989 adrenal malignancies were identified in the 2012-2015 cohort. The most common histologies were ACC (26.4%), diffuse large B-cell lymphoma (DLBCL; 25.4%), neuroblastoma (22.2%), and MPCC (11.9%). While most ACC and MPCC patients were in their 60s, DLBCL patients accounted for 61.5% of adrenal malignancies in the over-70 cohort. Among ACC patients with clinical staging data, 46.3% of patients were stage IV. Although surgery was a chief strategy for all stages, younger patients tended to receive combination therapy, including surgery and chemotherapy or hormone therapy. In the 2008-2009 cohort, the 5-year OS rates of ACC (n = 49) and MPCC (n = 23) patients were 56.2% and 86.4% while ACC patients without surgery had 1- and 2-year OS rates of 25.0% and 12.5%. CONCLUSION In Japan, DLBCL accounted for the majority of adrenal malignancies in older patients. Despite advanced staging, ACC patients were mainly treated with surgery and their prognosis was not satisfactory. Such epidemiological data may be useful in considering initial management strategies.
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Affiliation(s)
- Ichiro Chihara
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | | | - Shuya Kandori
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Kosuke Kojo
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Keisuke Sano
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Kazuki Hamada
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Kozaburo Tanuma
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Haruki Tsuchiya
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Masanobu Shiga
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Shotaro Sakka
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Tomokazu Kimura
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | | | - Akio Hoshi
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | | | | | - Mathis J Bryan
- International Medical Center, University of Tsukuba Affiliated Hospital, Tsukuba, Japan
| | - Ayako Okuyama
- Center for Cancer Registries, National Cancer Center Institute for Cancer Control, Chuo-ku, Japan
| | - Takahiro Higashi
- Center for Cancer Registries, National Cancer Center Institute for Cancer Control, Chuo-ku, Japan
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15
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Adrenal Mass in a 70-Year-Old Woman. Case Rep Endocrinol 2022; 2022:2736199. [PMID: 35865995 PMCID: PMC9296303 DOI: 10.1155/2022/2736199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Adrenocortical carcinoma is a rare endocrine malignancy with a bimodal age distribution pattern that affects women more than men. More than half of the patients present with hormone excess manifestations such as Cushing's syndrome and virilization. Non-functional tumors usually are diagnosed incidentally following imaging studies due to a mass effect or metastatic disease. Surgical resection is considered the best curative treatment for these tumors. Case Presentation. A 70-year-old woman presented with a 3-month history of diffuse intermittent abdominal discomfort, weight loss, and additional hair growth. Imaging investigations revealed a large 187 × 85 × 140 mm mass between the liver and upper pole of the right kidney which has displaced the adjacent structures. Hormonal evaluations detected high levels of cortisol and adrenal androgens. She underwent open adrenalectomy and right nephrectomy due to severe adhesion of the mass. Histopathological evaluations revealed adrenocortical carcinoma and the patient received adjuvant radiotherapy. Conclusion Precise physical examination, hormonal evaluation, and imaging studies play a key role in differentiating malignant adrenal masses in all patients, especially in those with vague symptoms. Radical excision of the mass and appropriate adjuvant chemotherapy or radiotherapy improve the outcome for patients.
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16
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Adrenocortical Carcinoma: a Therapeutic Challenge — 44 Cases from a Single Tertiary Care Center in India. Indian J Surg Oncol 2022; 13:251-259. [DOI: 10.1007/s13193-021-01440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 09/01/2021] [Indexed: 10/20/2022] Open
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17
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Radiotherapy for Pediatric Adrenocortical Carcinoma – Review of the Literature. Clin Transl Radiat Oncol 2022; 35:56-63. [PMID: 35601796 PMCID: PMC9121070 DOI: 10.1016/j.ctro.2022.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy (RT) is mostly performed for curative intent, only few cases in palliative setting are reported. The site of RT was predominantly tumor bed, abdominal cavity, and/or metastases. Adjuvant RT has to be discussed—even in the context of TPSs—especially for patients with high risk factors. Evidence regarding RT in in pediatric adrenocortical carcinoma is too limited to give any general recommendation. However, we suggest to consider adjuvant radiotherapy in individual patients with high risk of recurrence. A systematic international study with a common data platform is needed to establish evidence. on the role of RT in the treatment of children with adrenocortical carcinoma and to improve the outcome in this rare disease.
Background and purpose Pediatric adrenocortical carcinoma (pACC) is a rare disease with poor prognosis. Publications on radiotherapy (RT) are scarce. This review summarizes the current data on RT for pACC and possibly provides first evidence to justify its use in this setting. Materials and methods We searched the PubMed and Embase database for manuscripts regarding RT for pACC. Results We included 17 manuscripts reporting on 76 patients treated with RT, after screening 2961 references and 269 full articles. In addition, we added data of 4 unreported pACC patients treated by co-authors. All reports based on retrospective data. Median age at first diagnosis was 11.1 years (70% female); 78% of patients presented with hormonal activity. RT was mostly performed for curative intent (78%). 88% of RT were administered during primary therapy. The site of RT was predominantly the local tumor bed (76%). Doses of RT ranged from 15 to 62 Gy (median 50 Gy). Information on target volumes or fractionation were lacking. Median follow-up was 6,9 years and 64% of the patients died of disease, with 33% alive without disease. In 16 of 48 patients with available follow-up data after adjuvant RT (33%) no recurrence was reported and in 3 of 9 patients palliative RT seemed to induce some benefit for the patient. Conclusions Our first systematic review on RT for pACC provides too few data for any general recommendation, but adjuvant RT in patients with high risk might be considered. International collaborative studies are urgently needed to establish better evidence on the role of RT in this rare malignancy.
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18
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Hahner S, Hartrampf PE, Mihatsch PW, Nauerz M, Heinze B, Hänscheid H, Teresa Fuß C, Werner RA, Pamporaki C, Kroiss M, Fassnacht M, Buck AK, Schirbel A. Targeting 11-Beta Hydroxylase With [131I]IMAZA: A Novel Approach for the Treatment of Advanced Adrenocortical Carcinoma. J Clin Endocrinol Metab 2022; 107:e1348-e1355. [PMID: 34904171 DOI: 10.1210/clinem/dgab895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with limited treatment options. Theranostic approaches with adrenal specific radiotracers hold promise for improved diagnostics and treatment. OBJECTIVE Here, we report a new theranostic approach to advanced ACC applying (R)-1-[1-(4-[123I]iodophenyl)ethyl]-1H-imidazole-5-carboxylic acid azetidinyl amide ([123I]IMAZA) for diagnostic imaging and [131I]IMAZA for radionuclide therapy. METHODS Sixty-nine patients with nonresectable, metastatic ACCs were screened using a diagnostic [123I]IMAZA scan. Patients with significant uptake in all tumoral lesions were offered treatment with [131I]IMAZA. Tumor response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST version 1.1), and adverse effects were assessed by Common Toxicity Criteria (version 5.0). RESULTS After screening, 13 patients were treated with a median of 25.7 GBq [131I]IMAZA (range 18.1-30.7 GBq). Five individuals received a second treatment course. Best response was a decrease in the RECIST target lesions of -26% in 2 patients. Five patients with disease stabilization experienced a median progression-free survival of 14.3 months (range 8.3-21.9). Median overall survival in all patients was 14.1 months (4.0-56.5) after therapy. Treatment was well tolerated, in other words no severe toxicities (CTCAE grade ≥3) were observed. CONCLUSION In patients with advanced ACC refractory to standard therapeutic regimens, [131I]IMAZA treatment was associated with disease stabilization and nonsignificant tumor size reduction in a significant patient fraction and only limited toxicities. High [131I]IMAZA-uptake in tumor lesions was observed in 38.5% of patients with advanced ACC, rendering [131I] IMAZA a potential treatment option in a limited, well-defined patient fraction. Further clinical trials will be necessary to evaluate the full potential of this novel theranostic approach.
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Affiliation(s)
- Stefanie Hahner
- Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Philipp E Hartrampf
- Department of Nuclear Medicine, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Patrick W Mihatsch
- Department of Diagnostic and Interventional Radiology, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Marc Nauerz
- Department of Nuclear Medicine, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Britta Heinze
- Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Heribert Hänscheid
- Department of Nuclear Medicine, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Carmina Teresa Fuß
- Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Rudolf A Werner
- Department of Nuclear Medicine, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Christina Pamporaki
- Division of Endocrinology, Department of Internal Medicine III, University Hospital, University of Dresden, Fetscherstraße 74, D-01307 Dresden, Germany
| | - Matthias Kroiss
- Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
- Department of Internal Medicine IV, University Hospital Munich, Ludwig-Maximilians-Universität München, Ziemssenstraße 5, D-80336 Munich, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
| | - Andreas Schirbel
- Department of Nuclear Medicine, University Hospital, University of Würzburg, Oberdürrbacher Straße 6, D-97080 Würzburg, Germany
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Ma J, Jin Y, Gong B, Li L, Zhao Q. Pan-cancer analysis of necroptosis-related gene signature for the identification of prognosis and immune significance. Discov Oncol 2022; 13:17. [PMID: 35312867 PMCID: PMC8938586 DOI: 10.1007/s12672-022-00477-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/03/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Necroptosis is a novel programmed cell death mode independent on caspase. A number of studies have revealed that the induction of necroptosis could act as an alternative therapeutic strategy for drug-resistant tumors as well as affect tumor immune microenvironment. METHODS Gene expression profiles and clinical data were downloaded from XENA-UCSC (including The Cancer Genome Atlas and Genotype-Tissue Expression), Gene Expression Omnibus, International Cancer Genome Consortium and Chinese Glioma Genome Atlas. We used non-negative matrix factorization method to conduct tumor classification. The least absolute shrinkage and selection operator regression was applied to establish risk models, whose prognostic effectiveness was examined in both training and testing sets with Kaplan-Meier analysis, time-dependent receiver operating characteristic curves as well as uni- and multi-variate survival analysis. Principal Component Analysis, t-distributed Stochastic Neighbor Embedding and Uniform Manifold Approximation and Projection were conducted to check the risk group distribution. Gene Set Enrichment Analyses, immune infiltration analysis based on CIBERSORT, EPIC, MCPcounter, ssGSEA and ESTIMATE, gene mutation and drug sensitivity between the risk groups were also taken into consideration. RESULTS There were eight types of cancer with at least ten differentially expressed necroptosis-related genes which could influence patients' prognosis, namely, adrenocortical carcinoma (ACC), cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC), acute myeloid leukemia (LAML), brain lower grade glioma (LGG), pancreatic adenocarcinoma (PAAD), liver hepatocellular carcinoma (LIHC), skin cutaneous melanoma (SKCM) and thymoma (THYM). Patients could be divided into different clusters with distinct overall survival in all cancers above except for LIHC. The risk models could efficiently predict prognosis of ACC, LAML, LGG, LIHC, SKCM and THYM patients. LGG patients from high-risk group had a higher infiltration level of M2 macrophages and cancer-associated fibroblasts. There were more CD8+ T cells, Th1 cells and M1 macrophages in low-risk SKCM patients' tumor microenvironment. Gene mutation status and drug sensitivity are also different between low- and high-risk groups in the six cancers. CONCLUSIONS Necroptosis-related genes can predict clinical outcomes of ACC, LAML, LGG, LIHC, SKCM and THYM patients and help to distinguish immune infiltration status for LGG and SKCM.
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Affiliation(s)
- Jincheng Ma
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Department of Pediatric Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yan Jin
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Department of Pediatric Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Baocheng Gong
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Department of Pediatric Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Long Li
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Department of Pediatric Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Immune Microenvironment and Diseases of Educational Ministry of China, Department of Immunology, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, China
| | - Qiang Zhao
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Department of Pediatric Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
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20
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Wu K, Liu X, Liu Z, Lu Y, Wang X, Li X. Benefit of Postoperative Radiotherapy for Patients With Nonmetastatic Adrenocortical Carcinoma: A Population-Based Analysis. J Natl Compr Canc Netw 2021; 19:1425-1432. [PMID: 34902831 DOI: 10.6004/jnccn.2021.7035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is an aggressive cancer with high recurrence rates and poor prognosis, even after radical surgery. The survival benefit of adjuvant radiotherapy (RT) in patients with ACC has not been well explored. The aim of this study was to evaluate the effect of adjuvant RT on the survival outcome of patients with ACC. PATIENTS AND METHODS All patients with nonmetastatic ACC who underwent complete resection were identified from the SEER database (2004-2016). Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox regression analysis was performed to identify prognostic factors associated with survival. RESULTS Of 365 patients with nonmetastatic ACC, 55 (15.1%) received adjuvant RT and the remainder underwent surgery alone. Patient characteristics were similar between the 2 groups, but those with a higher disease stage were more likely to receive adjuvant RT. Overall, patients receiving RT seemed to have better survival compared with the non-RT group (3-year OS rate, 63.1% vs 52.8%; P<.062). After adjustment for confounding factors, adjuvant RT was indeed associated with a 48% decreased risk of death (hazard ratio, 0.52; 95% CI, 0.29-0.91; P=.023) for all patients. In addition, adjuvant RT may confer a survival benefit only in patients with a high risk of recurrence (3-year OS rate, 55.1% vs 40.0%; P=.048) rather than in those with low/moderate-risk ACC (P=.559). CONCLUSIONS Our findings suggest that adjuvant RT may be associated with improved survival in patients with nonmetastatic ACC who underwent radical surgery, especially those with high risk of recurrence.
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Affiliation(s)
- Kan Wu
- Department of Urology, Institute of Urology, and
| | - Xu Liu
- Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihong Liu
- Department of Urology, Institute of Urology, and
| | - Yiping Lu
- Department of Urology, Institute of Urology, and
| | | | - Xiang Li
- Department of Urology, Institute of Urology, and
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21
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Guarnotta V, Ferrigno R, Martino M, Barbot M, Isidori AM, Scaroni C, Ferrante A, Arnaldi G, Pivonello R, Giordano C. Glucocorticoid excess and COVID-19 disease. Rev Endocr Metab Disord 2021; 22:703-714. [PMID: 33025384 PMCID: PMC7538187 DOI: 10.1007/s11154-020-09598-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/15/2022]
Abstract
The pandemic of coronavirus disease (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is causing high and rapid morbidity and mortality. Immune system response plays a crucial role in controlling and resolving the viral infection. Exogenous or endogenous glucocorticoid excess is characterized by increased susceptibility to infections, due to impairment of the innate and adaptive immune system. In addition, diabetes, hypertension, obesity and thromboembolism are conditions overrepresented in patients with hypercortisolism. Thus patients with chronic glucocorticoid (GC) excess may be at high risk of developing COVID-19 infection with a severe clinical course. Care and control of all comorbidities should be one of the primary goals in patients with hypercortisolism requiring immediate and aggressive treatment. The European Society of Endocrinology (ESE), has recently commissioned an urgent clinical guidance document on management of Cushing's syndrome in a COVID-19 period. In this review, we aim to discuss and expand some clinical points related to GC excess that may have an impact on COVID-19 infection, in terms of both contagion risk and clinical outcome. This document is addressed to all specialists who approach patients with endogenous or exogenous GC excess and COVID-19 infection.
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Affiliation(s)
- Valentina Guarnotta
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", UOC di Malattie endocrine, del Ricambio e della Nutrizione, Università degli studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Rosario Ferrigno
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Marianna Martino
- Clinica di Endocrinologia e Malattie del Metabolismo, Dipartimento di Scienze Cliniche e Molecolari (DISCLIMO), Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - Mattia Barbot
- Endocrinology Unit, Department of Medicine, DIME University-Hospital of Padova, Padua, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Policlinico Umberto I, COVID Hospital, Sapienza University of Rome, 00161, Rome, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine, DIME University-Hospital of Padova, Padua, Italy
| | - Angelo Ferrante
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", UO di Reumatologia, Università degli studi di Palermo, Palermo, Italy
| | - Giorgio Arnaldi
- Clinica di Endocrinologia e Malattie del Metabolismo, Dipartimento di Scienze Cliniche e Molecolari (DISCLIMO), Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy.
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Carla Giordano
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", UOC di Malattie endocrine, del Ricambio e della Nutrizione, Università degli studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
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22
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Quan C, Zhang Y, Wang Y. Metastatic liver cancer with hormone secretion: a case report. Gland Surg 2021; 10:3053-3057. [PMID: 34804891 DOI: 10.21037/gs-21-296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
Adrenocortical carcinoma (ACC) is a very rare and challenging malignancy with a dismal prognosis. The patients usually suffer from primary or metastatic tumors, and about half of the tumors have hormone secretion function to cause Cushing's syndrome (CS) and hypercortisolism. The optimal management and clinical outcomes of ACC remain ill-defined due to the rarity of the disease. Due to the failure of effective treatment, surgery remains the main treatment for ACC, which includes distant resectable metastases and ACC recurrent. We reported a 34-year-old woman who was diagnosed with left-sided ACC at another hospital and then underwent left adrenalectomy for ACC 2 years ago. Then she was admitted to our hospital with CS caused by adrenocorticotropic hormone (ACTH) secretion from an ACC metastatic to the liver. She underwent a complete resection of the tumors in the liver and was discharged without any severe complications after hormone replacement therapy. Unfortunately, six months after the hepatectomy, she eventually died due to progressive deterioration and the refusal of further treatment. ACC is a rare and challenging disease with few durable systemic options. Due to the difficulty of full cure, prompt serial follow-up after the operation is probably crucial for a better prognosis.
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Affiliation(s)
- Cheng Quan
- Department of Vascular Surgery, the Second Hospital of Jilin University, Changchun, China
| | - Yingchao Zhang
- Department of Breast Surgery, the Second Hospital of Jilin University, Changchun, China
| | - Yu Wang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Jilin University, Changchun, China
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23
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Boilève A, Mathy E, Roux C, Faron M, Hadoux J, Tselikas L, Al Ghuzlan A, Hescot S, Leboulleux S, de Baere T, Lamartina L, Deschamps F, Baudin E. Combination of Mitotane and Locoregional Treatments in Low-volume Metastatic Adrenocortical Carcinoma. J Clin Endocrinol Metab 2021; 106:e4698-e4707. [PMID: 34143888 DOI: 10.1210/clinem/dgab449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 12/27/2022]
Abstract
CONTEXT European and French guidelines for ENSAT stage IV low tumor burden or indolent adrenocortical carcinoma (ACC) recommend a combination of mitotane and locoregional treatments (LRT) as first-line treatment. Nevertheless, the benefit of LRT in combination with mitotane has never been evaluated in this selected group of patients. OBJECTIVE This work aimed to evaluate the therapeutic strategy of LRT combined with mitotane in patients with low tumor burden stage IVA ACC. METHODS A retrospective chart review was performed from 2003 to 2018 of patients with stage IV ACC with 2 or fewer tumoral organs who received mitotane in our center. The primary end point was the delay between mitotane initiation and first systemic chemotherapy. Secondary end points were progression-free survival (PFS) and overall survival (OS) from mitotane initiation. Adjusted analyses were performed on the main prognostic factors. RESULTS Out of 79 included patients, 48 (61%) patients were female and the median age at stage IVA diagnosis was 49.8 years (interquartile range [IQR], 38.8-60.0 years). Metastatic sites were mainly lungs (76%) and liver (48%). Fifty-eight (73%) patients received LRT including adrenal bed radiotherapy (14 patients, 18%), surgery (37 patients, 47%), and/or interventional radiology (35 patients, 44%). Median time between mitotane initiation and first chemotherapy administration was 9 months (IQR, 4-18 months). Median PFS1 (first tumor-progression) was 6.0 months (95% CI, 4.5-8.6). Median OS was 46 months (95% CI, 41-68). PFS1, PFS2, and OS were statistically longer in the mitotane plus LRT group compared to the mitotane-only group (hazard ratio [HR] = 0.39; 95% CI, 0.22-0.68; HR = 0.35; 95% CI, 0.20-0.63; and HR = 0.27; 95% CI, 0.14-0.50, respectively). Ten (13%) patients achieved complete response (CR), all from the mitotane plus LRT group. CONCLUSION Our results endorse European and French guidelines for stage IV ACC with 2 or fewer tumor organs and favor the combination of mitotane and LRT as first-line treatment. For the first time, a significant number of CRs were observed. Prospective studies are expected to confirm these findings.
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Affiliation(s)
- Alice Boilève
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Elise Mathy
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Charles Roux
- Institut Gustave Roussy, Département de radiologie interventionnelle, Villejuif, France
| | - Matthieu Faron
- Institut Gustave Roussy, Département de chirurgie, Villejuif, France
| | - Julien Hadoux
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Lambros Tselikas
- Institut Gustave Roussy, Département de radiologie interventionnelle, Villejuif, France
| | - Abir Al Ghuzlan
- Institut Gustave Roussy, Département d'anatomopathologie, Villejuif, France
| | - Ségolène Hescot
- Institut Curie, Département de médecine oncologique, Paris, France
| | - Sophie Leboulleux
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Thierry de Baere
- Institut Gustave Roussy, Département de radiologie interventionnelle, Villejuif, France
| | - Livia Lamartina
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Frédéric Deschamps
- Institut Gustave Roussy, Département de radiologie interventionnelle, Villejuif, France
| | - Eric Baudin
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
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Shebrain S. Prediction of Survival in Adrenocortical Carcinoma. J INVEST SURG 2021; 35:1161-1162. [PMID: 34663167 DOI: 10.1080/08941939.2021.1991057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Saad Shebrain
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
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25
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Mao Y, Alimu P, Wang C, Ma W, Zhuo R, Sun F. High TNFSF13B expression as a predictor of poor prognosis in adrenocortical carcinoma. Transl Androl Urol 2021; 10:3275-3285. [PMID: 34532252 PMCID: PMC8421843 DOI: 10.21037/tau-21-232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 11/12/2022] Open
Abstract
Background Adrenocortical carcinoma (ACC) is an extremely rare malignant tumor with poor prognosis. Existing treatment options have limited effects, and new therapeutic targets urgently need to be discovered. TNFSF13B has been reported to be associated with the prognosis of clear cell renal cell carcinoma, but it has not been studied in ACC. Methods TNFSF13B expression was analyzed and compared between ACC tumors and normal tissues by using public datasets from TCGA and GTEx. Kaplan-Meier analysis was employed to evaluate survival, and Cox regression was employed to evaluate clinicopathologic features. The upstream and downstream regulatory mechanisms of TNFSF13B were also analyzed. GSEA was performed to explore the mechanisms of TNFSF13B in ACC. Finally, 14 ACC clinical samples were used to verify the relationships between TNFSF13B expression and disease-free survival (DFS) and overall survival (OS). Results TNFSF13B expression was significantly higher in ACC tissues than in normal tissues. The prognosis of ACC patients with high TNFSF13B expression was worse than that of patients with low TNFSF13B expression. High TNFSF13B expression was strongly correlated with poor prognosis, and TNFSF13B was a prognostic factor. TNFSF13B expression is modified by upstream miRNAs, methylation and ubiquitination, and downstream, it interacts with other proteins. GSEA showed that regulation of cholesterol biosynthesis by SREBP and SREBF, downstream signaling events of the B cell receptor (BCR) and activation of gene expression by SREBF and SREBP were significantly enriched in the TNFSF13B high-expression phenotype. Clinical samples confirmed that TNFSF13B expression was significantly associated with DFS but not with OS. Conclusions TNFSF13B may be a potential prognostic molecular marker of poor survival in ACC patients, offering a new therapeutic target.
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Affiliation(s)
- Yongxin Mao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Parehe Alimu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenghe Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenming Ma
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ran Zhuo
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fukang Sun
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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26
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Wang W, Chang G, Sun Y, Zhuo R, Li H, Hu Y, Ye C. Nomograms for Individualized Evaluation of Prognosis in Adrenocortical Carcinomas for the Elderly: A Population-Based Analysis. J INVEST SURG 2021; 35:1153-1160. [PMID: 34433351 DOI: 10.1080/08941939.2021.1968981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is extremely rare in elderly patients. Thus, this study aimed to identify the incidence rate and develop nomogram models for predicting survival in elderly ACC patients. METHODS Data of ACC patients aged >60 years from 1975 to 2016 were obtained from the Surveillance, Epidemiology, and End Results dataset. The national incidence rate was estimated, and survival was subjected to Kaplan-Meier analysis. A multivariate Cox regression model was used to identify predictors of survival. Nomograms were generated to predict survival, calibrated and internally validated. RESULTS We identified 583 cases. Univariate analysis showed that patients with younger age (≤67 years), female sex, lower tumor grade, surgical treatment performed, and earlier European Network for the Study of Adrenal Tumors (ENSAT) stage had a better survival (P < 0.05). In the Cox regression analysis, no surgery performed (hazard ratio [HR]: 3.544, 95% CI: 1.142-10.995, P = 0.029 for overall survival [OS]; HR: 3.230, 95% CI: 1.040-10.034, P = 0.043 for disease-specific survival [DSS]) and advanced ENSAT stage (HR: 3.328, 95% CI: 1.628-6.801, P = 0.001 for OS; HR: 3.701, 95% CI: 1.682-8.141, P = 0.001 for DSS) were associated with worse outcomes. Age, sex, histologic grade, surgical resection, radiotherapy, and ENSAT stage were included in the nomograms, with a C-index of 0.692 for OS and 0.694 for DSS, demonstrating a good accuracy in predicting survival. CONCLUSIONS This study is the largest review of ACC in elderly patients. We present nomograms to predict survival in elderly ACC patients using clinicopathologic data, which could aid in accurate clinical decision-making.
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Affiliation(s)
- Weixi Wang
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Guilin Chang
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Yan Sun
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Ran Zhuo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Huiting Li
- Department of Respiratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Hu
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Cong Ye
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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The Immunotherapy Landscape in Adrenocortical Cancer. Cancers (Basel) 2021; 13:cancers13112660. [PMID: 34071333 PMCID: PMC8199088 DOI: 10.3390/cancers13112660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare cancer of the adrenal gland that is frequently associated with excess production of adrenal hormones. Although surgical resection may be curative in early-stage disease, few effective therapeutic options exist in the inoperable advanced or metastatic setting. Immunotherapies, inclusive of a broad array of immune-activating and immune-modulating antineoplastic agents, have demonstrated clinical benefit in a wide range of solid and hematologic malignancies. Due to the broad activity across multiple cancer types, there is significant interest in testing these agents in rare tumors, including ACC. Multiple clinical trials evaluating immunotherapies for the treatment of ACC have been conducted, and many more are ongoing or planned. Immunotherapies that have been evaluated in clinical trials for ACC include the immune checkpoint inhibitors pembrolizumab, nivolumab, and avelumab. Other immunotherapies that have been evaluated include the monoclonal antibodies figitumumab and cixutumumab directed against the ACC-expressed insulin-like growth factor 1 (IGF-1) receptor, the recombinant cytotoxin interleukin-13-pseudomonas exotoxin A, and autologous tumor lysate dendritic cell vaccine. These agents have shown modest clinical activity, although nonzero in the case of the immune checkpoint inhibitors. Clinical trials are ongoing to evaluate whether this clinical activity may be augmented through combinations with other immune-acting agents or targeted therapies.
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28
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Patel S, Vogel J, Bradley K, Chuba PJ, Buchsbaum J, Krasin MJ. Rare tumors: Retinoblastoma, nasopharyngeal cancer, and adrenocorticoid tumors. Pediatr Blood Cancer 2021; 68 Suppl 2:e28253. [PMID: 33818883 DOI: 10.1002/pbc.28253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
The role of surgery, chemotherapy, and radiation therapy for retinoblastoma has evolved considerably over the years with the efficacy of intraarterial chemotherapy and the high incidence of secondary malignant neoplasms following radiation therapy. The use of spot scanning intensity-modulated proton therapy may reduce the risk of secondary malignancies. For pediatric nasopharyngeal carcinoma, the current standard of care is induction chemotherapy followed by chemoradiation therapy. For adrenocortical carcinoma, the mainstay of treatment is surgery and chemotherapy. The role of radiation therapy remains to be defined.
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Affiliation(s)
- Samir Patel
- Divisions of Radiation Oncology and Pediatric Hematology, Oncology and Palliative Care, University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | - Jennifer Vogel
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristin Bradley
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul J Chuba
- Department of Radiation Oncology, St. John Providence Health Systems Webber Cancer Center, Warren, Michigan
| | - Jeffrey Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Thomas JJ, Tward JD. Stage Presentation, Care Patterns, Treatment Outcomes, and Impact of Radiotherapy on Overall Survival for Adrenocortical Carcinoma. Clin Genitourin Cancer 2021; 19:417-424. [PMID: 33858789 DOI: 10.1016/j.clgc.2021.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 12/08/2022]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare cancer with few well-powered studies regarding epidemiology or outcomes and even fewer studies to guide an evidence-based management approach. The effect of radiation therapy (RT) is particularly understudied and remains unclear, outside of general oncologic principles. We sought to describe current care patterns in the management of ACC and how these practices affect survival outcomes using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients with ACC who could be staged by the American Joint Committee on Cancer (AJCC) system diagnosed between 1988 and 2015 were included. A classification and regression tree analysis identified subgroups of patients who may have benefitted from RT. Multivariable Cox regression analysis was used to compare overall survival (OS). Propensity score adjustment was used to compare OS for a subset of node-negative, nonmetastatic patients who received adjuvant RT following radical surgery. RESULTS Among 865 eligible patients included in the analysis, only 10.5% received RT. In stage III node-negative patients, adjuvant RT following radical surgery was associated with a significantly improved OS compared with surgery alone. CONCLUSION Medically fit persons with stage III, node-negative ACC should receive adjuvant RT after surgical resection.
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Affiliation(s)
- Justin J Thomas
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX
| | - Jonathan D Tward
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT.
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Adrenal Surgery for Synchronously Metastatic Adrenocortical Carcinoma: A Population-Based Analysis. World J Surg 2021; 45:1457-1465. [PMID: 33481081 DOI: 10.1007/s00268-021-05957-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Metastatic adrenocortical carcinoma (ACC) is an aggressive cancer with poor prognosis, with limited treatment options. The survival benefit of adrenal surgery in patients with synchronous metastatic disease has not been well explored. METHODS Patients with ACC with synchronous metastases were identified from the Surveillance, Epidemiology, and End Results database (2010-2016). The effect of adrenal surgery on different patterns of distant metastases was assessed. The overall survival was estimated by the Kaplan-Meier method. Multivariable Cox regression analysis was performed to identify prognostic factors associated with survival outcome. RESULTS A total of 202 patients with synchronous metastatic ACC were identified from the SEER database, 76 (37.6%) patients underwent adrenal surgery. Compared to nonsurgical patients, patients who underwent adrenal surgery had a better survival (median overall survival: 4 vs. 13 months, P < 0.001). In sub-analyses, except for patients with liver metastases (P = 0.670), adrenalectomy could consistently confer a significant survival benefit in patients with lung metastases (P = 0.003), bone metastases (P = 0.020), and multiple metastases (P = 0.002). Cox regression analysis revealed that in addition to adrenalectomy [hazard ratio (HR) = 0.64, 95% confidence interval (CI) 0.45-0.92; P = 0.017], metastasectomy (HR = 0.48, 95% CI 0.26-0.86; P = 0.013), and chemotherapy (HR = 0.59, 95% CI 0.42-0.82; P = 0.002) were also associated with improved survival. CONCLUSIONS Our findings support the view that adrenal surgery may be associated with improved survival in patients with synchronous metastatic ACC (except for patients with liver metastases), and the metastatic sites have significant prognostic implications on survival outcomes with adrenal surgery.
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Alyateem G, Nilubol N. Current Status and Future Targeted Therapy in Adrenocortical Cancer. Front Endocrinol (Lausanne) 2021; 12:613248. [PMID: 33732213 PMCID: PMC7957049 DOI: 10.3389/fendo.2021.613248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/25/2021] [Indexed: 12/11/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. The current treatment standards include complete surgical resection for localized resectable disease and systemic therapy with mitotane alone or in combination with etoposide, doxorubicin, and cisplatin in patients with advanced ACC. However, the efficacy of systemic therapy in ACC is very limited, with high rates of toxicities. The understanding of altered molecular pathways is critically important to identify effective treatment options that currently do not exist. In this review, we discuss the results of recent advanced in molecular profiling of ACC with the focus on dysregulated pathways from various genomic and epigenetic dysregulation. We discuss the potential translational therapeutic implication of molecular alterations. In addition, we review and summarize the results of recent clinical trials and ongoing trials.
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Manso J, Sharifi-Rad J, Zam W, Tsouh Fokou PV, Martorell M, Pezzani R. Plant Natural Compounds in the Treatment of Adrenocortical Tumors. Int J Endocrinol 2021; 2021:5516285. [PMID: 34567112 PMCID: PMC8463247 DOI: 10.1155/2021/5516285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/14/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023] Open
Abstract
Plant natural products are a plethora of diverse and complex molecules produced by the plant secondary metabolism. Among these, many can reserve beneficial or curative properties when employed to treat human diseases. Even in cancer, they can be successfully used and indeed numerous phytochemicals exert antineoplastic activity. The most common molecules derived from plants and used in the fight against cancer are polyphenols, i.e., quercetin, genistein, resveratrol, curcumin, etc. Despite valuable data especially in preclinical models on such compounds, few of them are currently used in the medical practice. Also, in adrenocortical tumors (ACT), phytochemicals are scarcely or not at all used. This work summarizes the available research on phytochemicals used against ACT and adrenocortical cancer, a very rare disease with poor prognosis and high metastatic potential, and wants to contribute to stimulate preclinical and clinical research to find new therapeutic strategies among the overabundance of biomolecules produced by the plant kingdom.
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Affiliation(s)
- Jacopo Manso
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
| | - Javad Sharifi-Rad
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
| | - Wissam Zam
- Analytical and Food Chemistry Department, Faculty of Pharmacy, Tartous University, Tartous, Syria
| | | | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, Centre for Healthy Living, University of Concepción, Concepción 4070386, Chile
- Universidad de Concepción, Unidad de Desarrollo Tecnológico, UDT, Concepción 4070386, Chile
| | - Raffaele Pezzani
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
- Phytotherapy Lab, Endocrinology Unit, Department of Medicine (DIMED), University of Padova, via Ospedale 105, 35128 Padova, Italy
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Kiseljak-Vassiliades K, Bancos I, Hamrahian A, Habra M, Vaidya A, Levine AC, Else T. American Association of Clinical Endocrinology Disease State Clinical Review on the Evaluation and Management of Adrenocortical Carcinoma in an Adult: a Practical Approach. Endocr Pract 2020; 26:1366-1383. [PMID: 33875173 DOI: 10.4158/dscr-2020-0567] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this Disease State Clinical Review is to provide a practical approach to patients with newly diagnosed adrenocortical carcinoma, as well as to follow-up and management of patients with persistent or recurrent disease. METHODS This is a case-based clinical review. The provided recommendations are based on evidence available from randomized prospective clinical studies, cohort studies, cross-sectional and case-based studies, and expert opinions. RESULTS Adrenocortical carcinoma is a rare malignancy, often with poor outcomes. For any patient with an adrenal mass suspicious for adrenocortical carcinoma, the approach should include prompt evaluation with detailed history and physical exam, imaging, and biochemical adrenal hormone assessment. In addition to adrenal-focused imaging, patients should be evaluated with chest-abdomen-pelvis cross-sectional imaging to define the initial therapy plan. Patients with potentially resectable disease limited to the adrenal gland should undergo en bloc open surgery by an expert surgeon. For patients presenting with advanced or recurrent disease, a multidisciplinary approach considering curative repeat surgery, local control with surgery, radiation therapy or radiofrequency ablation, or systemic therapy with mitotane and/or cytotoxic chemotherapy is recommended. CONCLUSION As most health care providers will rarely encounter a patient with adrenocortical carcinoma, we recommend that patients with suspected adrenocortical carcinoma be evaluated by an expert multidisciplinary team which includes clinicians with expertise in adrenal tumors, including endocrinologists, oncologists, surgeons, radiation oncologists, pathologists, geneticists, and radiologists. We recommend that patients in remote locations be followed by the local health care provider in collaboration with a multidisciplinary team at an expert adrenal tumor program. ABBREVIATIONS ACC = adrenocortical carcinoma; ACTH = adrenocorticotropic hormone; BRACC = borderline resectable adrenocortical carcinoma; CT = computed tomography; DHEAS = dehydroepiandrosterone sulfate; EDP = etoposide, doxorubicin, cisplatin; FDG = 18F-fluorodeoxyglucose; FNA = fine-needle aspiration; HU = Hounsfield units; IVC = inferior vena cava; LFS = Li-Fraumeni syndrome; MEN1 = multiple endocrine neoplasia type 1; MRI = magnetic resonance imaging; OAC = oncocytic adrenocortical carcinoma; PC = palliative care; PET = positron emission tomography.
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Affiliation(s)
- Katja Kiseljak-Vassiliades
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine at Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Amir Hamrahian
- Division of Endocrinology, Johns Hopkins Hospital, Baltimore, Maryland
| | - MouhammedAmir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alice C Levine
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tobias Else
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
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Magony A, Mutsaers A, Ahmad B. Recurrence-free survival following aggressive multimodal treatment of an isolated recurrence of adrenocortical carcinoma. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2020. [DOI: 10.2217/ije-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 43-year old woman demonstrated an intra-abdominal drop metastasis 6 years after initial presentation of stage-III adrenocortical carcinoma (ACC), previously treated with resection, adjuvant radiation and mitotane therapy. This recurrence was managed aggressively with complete excision, adjuvant radiation and mitotane. Imaging at 3.25-year follow-up showed no evidence of recurrence, a remarkable response given ACC’s poor prognosis and high recurrence rates. Management of oligometastatic ACC remains unclear and intra-abdominal drop metastases are particularly rare in ACC; both require further documentation. Aggressive management with adjuvant radiation and mitotane therapy may represent an effective and well-tolerated approach for improving local control for recurrent ACC, including drop metastases. Further research is required to codify potential benefits.
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Affiliation(s)
- Alexander Magony
- Schulich School of Medicine, Western University, London, Ontario N6A 5C1, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario M5S 3H2, Canada
| | - Adam Mutsaers
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario N6A 5W9, Canada
| | - Belal Ahmad
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario N6A 5W9, Canada
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Miele E, Di Giannatale A, Crocoli A, Cozza R, Serra A, Castellano A, Cacchione A, Cefalo MG, Alaggio R, De Pasquale MD. Clinical, Genetic, and Prognostic Features of Adrenocortical Tumors in Children: A 10-Year Single-Center Experience. Front Oncol 2020; 10:554388. [PMID: 33178583 PMCID: PMC7593337 DOI: 10.3389/fonc.2020.554388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background and Aims: Pediatric adrenocortical tumors (ACTs) are very rare endocrine neoplasms in childhood. In this study, we performed a retrospective analysis of children with ACT treated at our institution by examining clinical and genetic disease features, treatment strategies, and outcomes. Methods: We retrospectively analyzed a cohort of 13 children treated at the Bambino Gesù Children's Hospital from November 2010 to March 2020. Results: The median age at diagnosis was 17 months (range = 0–82 months). The female: male ratio was 3.3/1. Mixed symptomatology (>1 hormone abnormality) was the most common presentation (46.1%). In three cases, the tumor was detected during prenatal or perinatal echographic screening. All patients presented with localized disease at diagnosis and underwent total adrenalectomy. Six patients were identified as having malignancies according to the Wieneke scoring system, five benign, and two undetermined. Seven patients underwent mitotane adjuvant therapy for 12 months. There was metastatic disease in three patients, with no correlation with age or Wieneke score. The most common sites of metastases were the liver and lungs. Metastatic patients were treated with surgery (n = 2), mitotane (n = 1), chemotherapy (n = 2) associated with anti-EGFR (n = 1), or immunotherapy with anti-PD1 (pembrolizumab) (n = 1); two patients achieved complete disease remission. Overall 2- and 5-year survival rates were 100%, with a median follow-up of 5 years (range = 2–9.5 years). Two- and 5-year disease free survival was 76.9 and 84.6%, respectively (95% confidence interval = −66.78–114.76 months). All patients are alive, 12 without disease, and one with stable disease. Genetic analyses showed TP53 germline mutations in six of eight patients analyzed (five inherited, one de novo). One patient had Beckwith–Wiedemann syndrome, with mosaic paternal uniparental disomy of chromosome 11, in both neoplastic and healthy adrenal tissue. Conclusion: We report the cases of 13 patients treated for ACT, including 12 aged <4 years at diagnosis, with a relative short time from symptoms onset. Our cohort experienced an excellent prognosis. TP53 mutation was found in 75% of tested patients (6/8) confirming the need to perform genetic tests and familial counseling in this disease.
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Affiliation(s)
- Evelina Miele
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Di Giannatale
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Department of Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaele Cozza
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annalisa Serra
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Aurora Castellano
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Cacchione
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Giuseppina Cefalo
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Alaggio
- Department of Laboratories, Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Debora De Pasquale
- Department of Paediatric Haematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Deschner BW, Stiles ZE, DeLozier OM, Drake JA, Tsao M, Glazer ES, Deneve JL, Yakoub D, Dickson PV. Critical analysis of lymph node examination in patients undergoing curative-intent resection for adrenocortical carcinoma. J Surg Oncol 2020; 122:1152-1162. [PMID: 32705677 DOI: 10.1002/jso.26138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare tumor and the role of lymph node dissection remains ill-defined. This study evaluates the effect of nodal examination on prognosis and survival in patients undergoing curative-intent resection of ACC. METHODS The National Cancer Database (2004-2015) was queried for patients undergoing margin-negative resection for ACC. Patients with distant metastases, neoadjuvant therapy, multivisceral resection and T4 tumors were excluded. RESULTS Among 897 patients, 147 (16.4%) had lymph nodes examined. Factors associated with lymph node examination included increasing tumor size (P < .001), extra-adrenal extension (P < .001), open operation (P < .001), and resection at an academic facility (P = .003). Lymph node metastasis was significantly associated with extra-adrenal tumor extension (P = .04). Lymph node harvest, regardless of the number of nodes examined, was not associated with a survival benefit. Median overall survival was incrementally worse with increasing number of positive lymph nodes (88.2 months for N0, 34.9 months for 1-3 positive nodes, and 15.6 months for ≥4 positive nodes, P < .001). CONCLUSIONS Lymph node harvest and lymph node metastasis were associated with more advanced tumors. Although nodal harvest did not offer a survival advantage, stratifying the nodal staging classification may provide important prognostic information.
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Affiliation(s)
- Benjamin W Deschner
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Zachary E Stiles
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Olivia M DeLozier
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Justin A Drake
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Miriam Tsao
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Evan S Glazer
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jeremiah L Deneve
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Danny Yakoub
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Paxton V Dickson
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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Lim JS, Lee SE, Kim JH, Kim JH. Characteristics of adrenocortical carcinoma in South Korea: a registry-based nationwide survey. Endocr Connect 2020; 9:519-529. [PMID: 32438344 PMCID: PMC7354716 DOI: 10.1530/ec-20-0196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the clinical characteristics and prognostic factors in patients with adrenocortical carcinoma (ACC) in South Korea. METHODS A nationwide, registry-based survey was conducted to identify pathologically proven ACC at 25 tertiary care centers in South Korea between 2000 and 2014. Cox proportional hazard model and log-rank test were adopted for survival analysis. RESULTS Two hundred four patients with ACC were identified, with a median follow-up duration of 20 months (IQR 5-52 months). The median age at diagnosis was 51.5 years (IQR 40-65.8 years), and ACC was prevalent in women (n = 110, 53.9%). Abdominal pain was the most common clinical symptom (n = 70, 40.2%), and ENSAT stage 2 was most common (n = 62, 30.4%) at the time of diagnosis. One hundred sixty-nine patients underwent operation, while 17 were treated with other modalities. The remission rate was 48%, and median recurrence-free survival time was 46 months. Estimated 5-year recurrence-free rate was 44.7%. There were more women, large tumor, atypical mitosis, venous invasion, and higher mitotic count in cancer recurrence group. Estimated 5-year overall survival and disease-specific survival rates were 64.5 and 70.6%, respectively. Higher ENSAT stage and advanced pathologic characteristics were risk factors for all-cause mortality of ACC. Large tumor size and cortisol-secreting tumor were additional risk factors for ACC-specific death. CONCLUSIONS We report the first epidemiologic study regarding ACC in an Asian population. ENSAT stage 4; lymph node involvement; non-operative group; and invasion of vein, sinusoid, or capsule were associated with an increased risk for all-cause mortality.
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Affiliation(s)
- Jung Soo Lim
- Department of Internal Medicine, Institute of Evidence-Based Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, South Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
- Correspondence should be addressed to J H Kim or J H Kim: or
| | - Jae Hyeon Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
- Correspondence should be addressed to J H Kim or J H Kim: or
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Cerquetti L, Bucci B, Carpinelli G, Lardo P, Proietti A, Saporito R, Rindi G, Petrangeli E, Toscano V, Stigliano A. Antineoplastic Effect of a Combined Mitotane Treatment/Ionizing Radiation in Adrenocortical Carcinoma: A Preclinical Study. Cancers (Basel) 2019; 11:cancers11111768. [PMID: 31717612 PMCID: PMC6895792 DOI: 10.3390/cancers11111768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/24/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Mitotane (MTT) is an adrenolytic drug used in adjuvant and advanced treatments of adrenocortical carcinoma (ACC). Ionizing radiation (IR) is also used in adrenal cancer treatment, even though its biological action remains unknown. To provide a reliable in vivo preclinical model of ACC, we used mouse xenografts bearing human ACC to test the effects of MTT and IR alone and in combination. We evaluated tumor growth inhibition by the RECIST criteria and analyzed the cell cycle by flow cytometry (FCM). In the xenograft ACC model treated with MTT/IR in combination, we observed a marked inhibition of tumor growth, with strong tumor regression (p < 0.0001) compared to MTT and IR given alone (p < 0.05). The MTT results confirm its antisteroidogenic activity (p < 0.05) in the xenograft ACC model, revealing its ability to render cancer cells more prone to radiotherapy treatment. In addition, to explain the biological effect of these treatments on the Mismatch Repair System (MMR), we interfered with the MSH2 gene expression in untreated and MTT/IR-treated H295R and SW13 cell lines. Moreover, we observed that upon treatment with MTT/IR to induce DNA damage, MSH2 gene inhibition in both the H295R and SW13 cell lines did not allow DNA damage repair, thus inducing cell death. In conclusion, MTT seems to have a radiosensitizing property and, when given in combination with IR, is able to promote neoplastic growth inhibition, leading to a significant reduction in tumor size due to cell death.
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Affiliation(s)
- Lidia Cerquetti
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.C.); (P.L.); (V.T.)
| | - Barbara Bucci
- UOC Pathological Clinic San Pietro Hospital Fatebenefratelli, 00189 Rome, Italy; (B.B.); (R.S.)
| | - Giulia Carpinelli
- Department of Cellular Biology and Neuroscience, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Pina Lardo
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.C.); (P.L.); (V.T.)
| | - Antonella Proietti
- Diagnostic of Laboratory Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Raffaele Saporito
- UOC Pathological Clinic San Pietro Hospital Fatebenefratelli, 00189 Rome, Italy; (B.B.); (R.S.)
| | - Guido Rindi
- Pathology Unit, University Catholic, 00168 Rome, Italy;
| | - Elisa Petrangeli
- CNR, Institute of Molecular Biology and Pathology, 00185 Rome, Italy;
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Vincenzo Toscano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.C.); (P.L.); (V.T.)
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.C.); (P.L.); (V.T.)
- Correspondence: ; Tel.: +39-6-3377-4784; Fax: +39-6-3377-6327
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Health-Related Quality of Life in Adrenocortical Carcinoma. Cancers (Basel) 2019; 11:cancers11101500. [PMID: 31597261 PMCID: PMC6826350 DOI: 10.3390/cancers11101500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022] Open
Abstract
Insight into the health-related quality of life (HRQoL) impact of adrenocortical carcinoma (ACC) is important. The disease and its treatment options potentially have an impact on HRQoL. For patients with limited survival, HRQoL research is of utmost importance. We will therefore provide an overview of HRQoL studies in patients with ACC. We found six studies that measured HRQoL in 323 patients with ACC (3 cross-sectional, 1 cohort, 2 trials), all indicating a reduced HRQoL compared to the general population. The FIRMACT trial found that HRQoL of patients with ACC was reduced compared to the general population, and that chemotherapy-mitotane further reduced HRQoL even though survival improved. Clinical aspects of the disease, including cortisol and aldosterone production and adrenal insufficiency have shown great impact on HRQoL in benign disease, even after the recovery of hormonal status. However, the impact of malignant adrenal disease and treatment options on HRQoL including adrenalectomy, radiotherapy, mitotane therapy, and chemotherapy have not been sufficiently studied in patients with ACC. Although the number of HRQoL studies in patients with ACC is limited, the existing literature does indicate that ACC has a large impact on patients' HRQoL, with disease specific aspects. Further HRQoL research in patients with ACC is essential to improve patient-centered care, preferably by using an ACC-specific HRQoL questionnaire.
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Gharzai LA, Green MD, Griffith KA, Else T, Mayo CS, Hesseltine E, Spratt DE, Ben-Josef E, Sabolch A, Miller BS, Worden F, Giordano TJ, Hammer GD, Jolly S. Adjuvant Radiation Improves Recurrence-Free Survival and Overall Survival in Adrenocortical Carcinoma. J Clin Endocrinol Metab 2019; 104:3743-3750. [PMID: 31220287 PMCID: PMC8926022 DOI: 10.1210/jc.2019-00029] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 04/04/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is a rare malignancy with high rates of recurrence and poor prognosis. The role of radiotherapy (RT) in localized ACC has been controversial, and RT is not routinely offered. OBJECTIVE To evaluate the benefit of adjuvant RT on outcomes in ACC. DESIGN This is a retrospective propensity-matched analysis. SETTING All patients were seen through the University of Michigan's Endocrine Oncology program, and all those who underwent RT were treated at the University of Michigan. PARTICIPANTS Of 424 patients with ACC, 78 were selected; 39 patients underwent adjuvant radiation. INTERVENTION Adjuvant RT to the tumor bed and adjacent lymph nodes. MAIN OUTCOMES MEASURES Time to local failure, distant failure, or death. RESULTS Median follow-up time was 4.21 years (95% CI, 2.79 to 4.94). The median radiation dose was 55 Gy (range, 45 to 60). The 3-year overall survival estimate for patients improved from 48.6% for patients without RT (95% CI, 29.7 to 65.2) to 77.7% (95% CI, 56.3 to 89.5) with RT, with a hazard ratio (HR) of 3.59 (95% CI, 1.60 to 8.09; P = 0.002). RT improved local recurrence-free survival (RFS) from 34.2% (95% CI, 18.8 to 50.3) to 59.5% (95% CI, 39.0 to 75.0), with an HR of 2.67 (95% CI, 1.38 to 5.19; P = 0.0035). RT improved all RFS from 18.3% (95% CI, 6.7 to 34.3) to 46.7% (95% CI, 26.9 to 64.3), with an HR 2.59 (95% CI, 1.40 to 4.79; P = 0.0024). CONCLUSIONS In the largest single institution study to date, adjuvant RT after gross resection of ACC improved local RFS, all RFS, and overall survival in this propensity-matched analysis. Adjuvant RT should be considered a part of multidisciplinary management for patients with ACC.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Michael D Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kent A Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Tobias Else
- Department of Endocrinology, University of Michigan, Ann Arbor, Michigan
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aaron Sabolch
- Department of Radiation Oncology, Kaiser Permanente, Portland, Oregon
| | - Barbara S Miller
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Francis Worden
- Department of Internal Medicine, Division of Medical Oncology, University of Michigan, Ann Arbor, Michigan
| | - Thomas J Giordano
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Gary D Hammer
- Department of Endocrinology, University of Michigan, Ann Arbor, Michigan
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
- Correspondence and Reprint Requests: Shruti Jolly, MD, Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Drive, UH B2 C490 SPC 5010, Ann Arbor, Michigan 48108. E-mail:
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Lorenz K, Langer P, Niederle B, Alesina P, Holzer K, Nies C, Musholt T, Goretzki PE, Rayes N, Quinkler M, Waldmann J, Simon D, Trupka A, Ladurner R, Hallfeldt K, Zielke A, Saeger D, Pöppel T, Kukuk G, Hötker A, Schabram P, Schopf S, Dotzenrath C, Riss P, Steinmüller T, Kopp I, Vorländer C, Walz MK, Bartsch DK. Surgical therapy of adrenal tumors: guidelines from the German Association of Endocrine Surgeons (CAEK). Langenbecks Arch Surg 2019; 404:385-401. [PMID: 30937523 DOI: 10.1007/s00423-019-01768-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Previous guidelines addressing surgery of adrenal tumors required actualization in adaption of developments in the area. The present guideline aims to provide practical and qualified recommendations on an evidence-based level reviewing the prevalent literature for the surgical therapy of adrenal tumors referring to patients of all age groups in operative medicine who require adrenal surgery. It primarily addresses general and visceral surgeons but offers information for all medical doctors related to conservative, ambulatory or inpatient care, rehabilitation, and general practice as well as pediatrics. It extends to interested patients to improve the knowledge and participation in the decision-making process regarding indications and methods of management of adrenal tumors. Furthermore, it provides effective medical options for the surgical treatment of adrenal lesions and balances positive and negative effects. Specific clinical questions addressed refer to indication, diagnostic procedures, effective therapeutic alternatives to surgery, type and extent of surgery, and postoperative management and follow-up regime. METHODS A PubMed research using specific key words identified literature to be considered and was evaluated for evidence previous to a formal Delphi decision process that finalized consented recommendations in a multidisciplinary setting. RESULTS Overall, 12 general and 52 specific recommendations regarding surgery for adrenal tumors were generated and complementary comments provided. CONCLUSION Effective and balanced medical options for the surgical treatment of adrenal tumors are provided on evidence-base. Specific clinical questions regarding indication, diagnostic procedures, alternatives to and type as well as extent of surgery for adrenal tumors including postoperative management are addressed.
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Affiliation(s)
- K Lorenz
- Universitätsklinikum Halle, Halle/Saale, Germany.
| | | | - B Niederle
- Ordination Siebenbrunnenstrasse, Wien, Austria
| | - P Alesina
- Kliniken Essen-Mitte, Essen, Germany
| | - K Holzer
- Universitätsklinikum Marburg, Marburg, Germany
| | - Ch Nies
- Marienhospital Osnabrück, Osnabrück, Germany
| | - Th Musholt
- Universitatsklinikum Mainz, Mainz, Germany
| | - P E Goretzki
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - N Rayes
- Universitätsklinikum Leipzig, Leipzig, Germany
| | - M Quinkler
- Endokrinologiepraxis Berlin, Berlin, Germany
| | - J Waldmann
- MIVENDO Klinik Hamburg, Hamburg, Germany
| | - D Simon
- Evangelisches Krankenhaus BETHESDA Duisburg, Duisburg, Germany
| | - A Trupka
- Klinikum Starnberg, Klinikum Starnberg, Germany
| | - R Ladurner
- Ludwig-Maximilians-Universität München, München, Germany
| | - K Hallfeldt
- Ludwig-Maximilians-Universität München, München, Germany
| | - A Zielke
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - D Saeger
- Universitätsklinikum Hamburg, Hamburg, Germany
| | - Th Pöppel
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - G Kukuk
- Universitätsklinikum Bonn, Bonn, Germany
| | - A Hötker
- Universitätsklinikum Zürich, Zürich, Switzerland
| | - P Schabram
- RAE Ratacjzak und Partner, Sindelfingen, Germany
| | - S Schopf
- Krankenhaus Agatharied, Hausham, Germany
| | - C Dotzenrath
- HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - P Riss
- Medizinische Universität Wien, Wien, Austria
| | - Th Steinmüller
- Deutsches Rotes Kreuz Krankenhaus Berlin, Berlin, Germany
| | - I Kopp
- AWMF, Frankfurt am Main, Germany
| | - C Vorländer
- Bürgerhospital Frankfurt, Frankfurt am Main, Germany
| | - M K Walz
- Kliniken Essen-Mitte, Essen, Germany
| | - D K Bartsch
- Universitätsklinikum Marburg, Marburg, Germany
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42
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Nuñez Bragayrac LA, Schwaab T. Adrenal Tumors. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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44
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Li Y, Bian X, Ouyang J, Wei S, He M, Luo Z. Nomograms to predict overall survival and cancer-specific survival in patients with adrenocortical carcinoma. Cancer Manag Res 2018; 10:6949-6959. [PMID: 30588100 PMCID: PMC6300377 DOI: 10.2147/cmar.s187169] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose To develop nomogram models to predict individualized estimates of overall survival (OS) and cancer-specific survival (CSS) in patients with adrenocortical carcinoma (ACC). Patients and methods A total of 751 patients with ACC were identified within the Surveillance Epidemiology, and End Results (SEER) database between 1973 and 2015. The predictors comprised marital status, sex, age at diagnosis, year of diagnosis, laterality, histologic grade, ethnicity, historic stage, radiation therapy, chemotherapy, and surgery of primary site. Based on the results of the multivariate logistic regression analyses, the nomogram models were used for predicting OS and CSS in patients with ACC. The nomograms were tested using concordance index (C-index) and calibration curves. Results In univariate and multivariate analyses of OS, OS was significantly associated with age at diagnosis, year of diagnosis, histologic grade, historic stage, and chemotherapy. In univariate and multivariate analyses of CSS, age at diagnosis, year of diagnosis, historic stage, and chemotherapy were the independent risk factors with CSS. These characteristics were included in the nomograms predicting OS and CSS. The nomograms demonstrated good accuracy in predicting OS and CSS, with the C-index of 0.677 and 0.672. Conclusion These clinically useful tools predicted OS and CSS in patients with ACC using readily available clinicopathologic factors and could aid individualized clinical decision making.
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Affiliation(s)
- Yan Li
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China,
| | - Xiaohui Bian
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Junyu Ouyang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Shuyi Wei
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Meizhi He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Zelong Luo
- Department of Oncology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China,
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Reibetanz J, Rinn B, Kunz AS, Flemming S, Ronchi CL, Kroiss M, Deutschbein T, Pulzer A, Hahner S, Kocot A, Germer CT, Fassnacht M, Jurowich C. Patterns of Lymph Node Recurrence in Adrenocortical Carcinoma: Possible Implications for Primary Surgical Treatment. Ann Surg Oncol 2018; 26:531-538. [DOI: 10.1245/s10434-018-6999-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Indexed: 12/20/2022]
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46
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Nelson DW, Goldfarb M. ASO Author Reflections: Incorporating Adjuvant Radiation into the Treatment Planning for Select Adrenocortical Carcinomas. Ann Surg Oncol 2018; 25:870-871. [PMID: 30324475 DOI: 10.1245/s10434-018-6909-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Melanie Goldfarb
- Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA. .,Center for Endocrine Tumors and Disorders, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
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Fassnacht M, Dekkers O, Else T, Baudin E, Berruti A, de Krijger R, Haak H, Mihai R, Assie G, Terzolo M. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2018; 179:G1-G46. [PMID: 30299884 DOI: 10.1530/eje-18-0608] [Citation(s) in RCA: 475] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare and in most cases steroid hormone-producing tumor with variable prognosis. The purpose of these guidelines is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with ACC based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions, which we judged as particularly important for the management of ACC patients and performed systematic literature searches: (A) What is needed to diagnose an ACC by histopathology? (B) Which are the best prognostic markers in ACC? (C) Is adjuvant therapy able to prevent recurrent disease or reduce mortality after radical resection? (D) What is the best treatment option for macroscopically incompletely resected, recurrent or metastatic disease? Other relevant questions were discussed within the group. Selected Recommendations: (i) We recommend that all patients with suspected and proven ACC are discussed in a multidisciplinary expert team meeting. (ii) We recommend that every patient with (suspected) ACC should undergo careful clinical assessment, detailed endocrine work-up to identify autonomous hormone excess and adrenal-focused imaging. (iii) We recommend that adrenal surgery for (suspected) ACC should be performed only by surgeons experienced in adrenal and oncological surgery aiming at a complete en bloc resection (including resection of oligo-metastatic disease). (iv) We suggest that all suspected ACC should be reviewed by an expert adrenal pathologist using the Weiss score and providing Ki67 index. (v) We suggest adjuvant mitotane treatment in patients after radical surgery that have a perceived high risk of recurrence (ENSAT stage III, or R1 resection, or Ki67 >10%). (vi) For advanced ACC not amenable to complete surgical resection, local therapeutic measures (e.g. radiation therapy, radiofrequency ablation, chemoembolization) are of particular value. However, we suggest against the routine use of adrenal surgery in case of widespread metastatic disease. In these patients, we recommend either mitotane monotherapy or mitotane, etoposide, doxorubicin and cisplatin depending on prognostic parameters. In selected patients with a good response, surgery may be subsequently considered. (vii) In patients with recurrent disease and a disease-free interval of at least 12 months, in whom a complete resection/ablation seems feasible, we recommend surgery or alternatively other local therapies. Furthermore, we offer detailed recommendations about the management of mitotane treatment and other supportive therapies. Finally, we suggest directions for future research.
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Affiliation(s)
- Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Olaf Dekkers
- Department of Clinical Epidemiology
- Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Else
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Baudin
- Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France
- INSERM UMR 1185, Faculté de Médecine, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Ronald de Krijger
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pathology, Reinier de Graaf Hospital, Delft, the Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Harm Haak
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Guillaume Assie
- Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Reference Center dor Rare Adrenal Cancers, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique UMR8104, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, Internal Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
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Tella SH, Kommalapati A, Yaturu S, Kebebew E. Predictors of Survival in Adrenocortical Carcinoma: An Analysis From the National Cancer Database. J Clin Endocrinol Metab 2018; 103:3566-3573. [PMID: 29982685 DOI: 10.1210/jc.2018-00918] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is rare; knowledge about prognostic factors and survival outcomes is limited. OBJECTIVE To describe predictors of survival and overall survival (OS) outcomes. DESIGN AND PATIENTS Retrospective analysis of data from the National Cancer Database (NCDB) from 2004 to 2015 on 3185 patients with pathologically confirmed ACC. MAIN OUTCOME MEASURES Baseline description, survival outcomes, and predictors of survival were evaluated in patients with ACC. RESULTS Median age at ACC diagnosis was 55 (range: 18 to 90) years; did not differ significantly by sex or stage of the disease at diagnosis. On multivariate analysis, increasing age, higher Charlson-Deyo comorbidity index score, high tumor grade, and no surgical therapy (all P < 0.0001); and stage IV disease (P = 0.002) and lymphadenectomy during surgery (P = 0.02) were associated with poor prognosis. Patients with stage I-III disease treated with surgical resection had significantly better median OS (63 vs 8 months; P < 0.001). In stage IV disease, better median OS occurred in patients treated with surgery (19 vs 6 months; P < 0.001), and postsurgical radiation (29 vs 10 months; P < 0.001) or chemotherapy (22 vs 13 months; P = 0.004). CONCLUSION OS varied with increasing age, higher comorbidity index, grade, and stage of ACC at presentation. There was improved survival with surgical resection of primary tumor, irrespective of disease stage; postsurgical chemotherapy or radiation was of benefit only in stage IV disease.
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Affiliation(s)
- Sri Harsha Tella
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Anuhya Kommalapati
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Subhashini Yaturu
- Division of Endocrinology, Wm. Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina
| | - Electron Kebebew
- Department of Surgery and Stanford Cancer Center, School of Medicine, Stanford University, Stanford, California
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Puglisi S, Perotti P, Cosentini D, Roca E, Basile V, Berruti A, Terzolo M. Decision-making for adrenocortical carcinoma: surgical, systemic, and endocrine management options. Expert Rev Anticancer Ther 2018; 18:1125-1133. [PMID: 30117750 DOI: 10.1080/14737140.2018.1510325] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare tumor characterized by poor prognosis in most cases. Moreover, in most cases ACC produces an excess of adrenal steroid hormones with relevant clinical consequences. Areas covered: After an extensive literature search, this narrative review addresses diagnostic management, including hormonal, radiological and pathological assessment, and treatment, which should be directed toward both cancer and hormone related problems. While surgery is the first option in ACC without evidence of metastatic disease, and the only possibility of cure, the therapeutic management of metastatic patients is centered on systemic therapy including mitotane alone or in combination with chemotherapy. Mitotane is also used in the adjuvant setting, because up to 80% of patients with nonmetastatic ACC show locoregional or distant metastases after an apparent complete surgical excision. Expert commentary: Management of ACC patients is fraught with many difficulties and should be limited to experienced physicians. Each step of clinical management, such as diagnosis, prognostication, treatment (both surgical and medical) is challenging and carries the possibility of severe mistakes. For this reason, each step of the management strategy should be decided in the setting of a multidisciplinary team including different expertise (endocrinology, radiology, pathology, oncology), in expert centers.
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Affiliation(s)
- Soraya Puglisi
- a Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital , University of Turin , Orbassano (TO) , Italy
| | - Paola Perotti
- a Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital , University of Turin , Orbassano (TO) , Italy
| | - Deborah Cosentini
- b Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Spedali Civili Hospital , University of Brescia , Brescia , Italy
| | - Elisa Roca
- b Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Spedali Civili Hospital , University of Brescia , Brescia , Italy
| | - Vittoria Basile
- a Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital , University of Turin , Orbassano (TO) , Italy
| | - Alfredo Berruti
- b Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Spedali Civili Hospital , University of Brescia , Brescia , Italy
| | - Massimo Terzolo
- a Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital , University of Turin , Orbassano (TO) , Italy
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Abstract
Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis. It has undergone in-depth clinical and laboratory investigations, with the help of the most important research groups all over the world. Nonetheless the cure for this kind of neoplasia is not right around the corner, given its complexity and multi-faceted feature, that lead researchers to think at "one person one ACC." Currently total resection is the most concrete option for ACC patients, whenever possible. Mitotane remains the main drug for primary or adjuvant therapy, but gives partial and unsatisfactory therapeutic results, especially in metastatic ACC. This prompted the researchers to find other ways to fight against this malignancy: targeted therapy seems the most promising answer, as it is based on biomolecular and genetic cancer signature. Numerous specific targets were explored for the treatment of ACC, such as those involving angiogenesis, steroidogenesis, Wnt/β-catenin pathway and many others key factors. Even if large efforts have been made, no effective target therapy entered in the clinical use. This data should not be considered only as detrimental, rather it should propel scientific research to invest more resources into the therapeutic exploration of ACC and in particular on the most promising strategy, the targeted therapy.
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Affiliation(s)
- Jacopo Manso
- Unit of Endocrinology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Raffaele Pezzani
- Unit of Endocrinology, Department of Medicine (DIMED), University of Padua, Padua, Italy - .,Associazione Italiana per la Ricerca Oncologica di Base (AIROB), Padua, Italy
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