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Ríos Medrano MA, Bigi MM, Martínez Ponce P, Podesta EJ, Orlando UD. Exposure to anticancer drugs modulates the expression of ACSL4 and ABCG2 proteins in adrenocortical carcinoma cells. Heliyon 2023; 9:e20769. [PMID: 37867801 PMCID: PMC10585233 DOI: 10.1016/j.heliyon.2023.e20769] [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: 04/13/2023] [Revised: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare and malignant disease, with more than 50 % of patients developing hormone-secreting tumors. These tumors are genetically heterogeneous and potentially lethal, as metastasis is often underway at the time of diagnosis. While chemoresistance can be multifactorial, Acyl CoA synthetase 4 (ACSL4) is known to contribute to the generation of highly aggressive cellular phenotypes, while increased expression and activity of multidrug transporters such as ATP-binding cassette subfamily G member 2 (ABCG2) are known to play a key role. Therefore, the objective of this work was to determine changes in the expression of ACSL4 and ABCG2 in ACC cell lines after exposure to antitumor drugs. Bioinformatics analysis of public database GSE140818 revealed higher ACSL4 and ABCG2 expression in HAC15 cells resistant to mitotane when compared to wild type cells. In addition, our studies revealed an increase in ACSL4 and ABCG2 expression in lowly aggressive H295R cells undergoing early treatment with non-lethal concentrations of mitotane, doxorubicin and cisplatin. Comparable results were obtained in lowly aggressive breast cancer cells MCF-7. The increase in ACSL4 and ABCG2 expression favored tumor cell viability, proliferation and compound efflux, an effect partially offset by ACSL4 and ABCG2 inhibitors. These results provide relevant data on the undesired molecular effects of antitumor drugs and may fuel future studies on patients' early response to antitumor treatment.
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Affiliation(s)
- Mayra Agustina Ríos Medrano
- Universidad de Buenos Aires-CONICET. Instituto de Investigaciones Biomédicas (INBIOMED). Buenos Aires. Argentina
| | - María Mercedes Bigi
- Universidad de Buenos Aires-CONICET. Instituto de Investigaciones Biomédicas (INBIOMED). Buenos Aires. Argentina
| | - Paloma Martínez Ponce
- Universidad de Buenos Aires-CONICET. Instituto de Investigaciones Biomédicas (INBIOMED). Buenos Aires. Argentina
| | - Ernesto Jorge Podesta
- Universidad de Buenos Aires-CONICET. Instituto de Investigaciones Biomédicas (INBIOMED). Buenos Aires. Argentina
- Universidad de Buenos Aires. Facultad de Medicina. Departamento de Bioquímica Humana. Buenos Aires. Argentina
| | - Ulises Daniel Orlando
- Universidad de Buenos Aires-CONICET. Instituto de Investigaciones Biomédicas (INBIOMED). Buenos Aires. Argentina
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Novel Insights into the Molecular Regulation of Ribonucleotide Reductase in Adrenocortical Carcinoma Treatment. Cancers (Basel) 2021; 13:cancers13164200. [PMID: 34439352 PMCID: PMC8391410 DOI: 10.3390/cancers13164200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary The current clinical gold standard etoposide, doxorubicin, cisplatin, and mitotane (EDP-M) is not satisfying for the treatment of adrenocortical carcinoma (ACC). However, clinical translation of novel, preclinically promising therapies were unfortunately disappointing in recent years, indicating that utilized tumor models inadequately predicted clinical applicability of novel pharmacological approaches. In an attempt to optimize the current preclinical armamentarium, our workgroup initiated a comparative drug screen of clinically relevant chemotherapies and therapies targeting IGF, EGF, and Wnt signaling pathways in the classical NCI-H295R cell line and, for the first time, in the recently developed highly drug-resistant MUC-1 cell line. These testings revealed gemcitabine and cisplatin as a promising combination, but further investigations also indicated developing drug resistance mechanisms on the molecular level. We aimed to decipher underlying resistance mechanisms, identified ribonucleotide reductase as an important player, and successfully targeted the involved DNA damage/repair mechanism. Abstract Current systemic treatment options for patients with adrenocortical carcinomas (ACCs) are far from being satisfactory. DNA damage/repair mechanisms, which involve, e.g., ataxia-telangiectasia-mutated (ATM) and ataxia-telangiectasia/Rad3-related (ATR) protein signaling or ribonucleotide reductase subunits M1/M2 (RRM1/RRM2)-encoded ribonucleotide reductase (RNR) activation, commonly contribute to drug resistance. Moreover, the regulation of RRM2b, the p53-induced alternative to RRM2, is of unclear importance for ACC. Upon extensive drug screening, including a large panel of chemotherapies and molecular targeted inhibitors, we provide strong evidence for the anti-tumoral efficacy of combined gemcitabine (G) and cisplatin (C) treatment against the adrenocortical cell lines NCI-H295R and MUC-1. However, accompanying induction of RRM1, RRM2, and RRM2b expression also indicated developing G resistance, a frequent side effect in clinical patient care. Interestingly, this effect was partially reversed upon addition of C. We confirmed our findings for RRM2 protein, RNR-dependent dATP levels, and modulations of related ATM/ATR signaling. Finally, we screened for complementing inhibitors of the DNA damage/repair system targeting RNR, Wee1, CHK1/2, ATR, and ATM. Notably, the combination of G, C, and the dual RRM1/RRM2 inhibitor COH29 resulted in previously unreached total cell killing. In summary, we provide evidence that RNR-modulating therapies might represent a new therapeutic option for ACC.
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Tkachuk AV, Tertychnyi AS, Beltsevich DG, Roslyakova AA, Belousov PV, Selivanova LS. [Adrenocortical cancer: morphological variants, immunohistochemical characteristics]. Arkh Patol 2021; 83:10-18. [PMID: 33822549 DOI: 10.17116/patol20218302110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adrenocortical cancer (ACC) is a rare endocrine malignancy of the adrenal cortex, which has an unfavorable prognosis and extremely aggressive clinical behavior in most cases. Nevertheless, cases of a more favorable disease course with late metastasis and slow progression have been described. In 2017, the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) in the 4th edition of the Classification of Tumors of the Endocrine Organs identified histological variants of ACC, such as classical, oncocytic, myxoid, and sarcomatoid ones, indicating the morphological heterogeneity of this tumor. OBJECTIVE To provide a detailed description of the morphological variants of ACC with an emphasis on their histological characteristics and the expression of immunohistochemical markers. MATERIALS AND METHODS A total of 75 cases of ACC were analyzed in the adult population diagnosed as having the morphological variants in accordance with the International Histological Classification of Adrenal Tumors (WHO, 2017). Monoclonal antibodies to SF1, Inhibin A, Melan A, Ki-67, p53, and antimitochondrial antibodies were used for immunohistochemical diagnosis. RESULTS The classic, oncocytic, and myxoid subtypes of ACC were found in 51 (68%), 15 (20%), and 9 (12%) cases, respectively. The functional activity of the tumors was observed in 43% (n=18) in the classic variant of ACC; moreover, the clinical picture was manifested by the symptoms of hypercorticism (38%) and virilization (5%). There were no significant differences in hormonal activity between different morphological variants. The characteristics of the above histological variants of the tumor was determined with a description of growth patterns that can improve the diagnosis of ACC. The diagnosis of ACC can be confirmed by an immunohistochemical study; the required minimum panel of markers should include SF1, Melan A, and Inhibin A. The Ki-67 proliferative activity index showed significant differences (p=0.0056) when it was determined in the morphological variants of ACC. CONCLUSION Despite the determination of a minimal immunohistochemical panel to confirm the diagnosis of ACC, it is important to remember that each histological variant may be characterized by the different expression of immunohistochemical markers. The identification of morphological variants of ACC and the use of specific, sensitive, and prognostically significant immunohistochemical markers will allow clinicians and pathologists to more accurately judge the biological properties of this tumor and the clinical course of the disease.
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Affiliation(s)
- A V Tkachuk
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
| | - A S Tertychnyi
- I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russia
| | - D G Beltsevich
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
| | - A A Roslyakova
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
| | - P V Belousov
- V.A. Engelhardt Institute of Molecular Biology of the Russian Academy of Sciences, Moscow, Russia
| | - L S Selivanova
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
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Hazimeh Y, Sigel C, Carie C, Leinung M, Khalaf Z. Adrenocortical Carcinoma: A Case of Missed Diagnosis. Cureus 2021; 13:e14235. [PMID: 33948420 PMCID: PMC8087872 DOI: 10.7759/cureus.14235] [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: 11/05/2022] Open
Abstract
Incidentalomas are commonly encountered adrenal lesions. However, adrenocortical carcinoma (ACC) represents a rare etiology of adrenal incidentalomas (AI). The diagnosis of AI is generally based on laboratory data and imaging results, Fine needle aspiration (FNA) is not usually indicated in the workup of incidentaloma. In this report, we present a case of AI in which two FNA procedures failed to make the correct diagnosis of ACC.
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Affiliation(s)
- Yusef Hazimeh
- Endocrinology, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Carlie Sigel
- Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | | - Zaynab Khalaf
- Endocrinology, Diabetes and Metabolism, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
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Lu S, Dhillon J, Johnson JH, El-Haddad G. Yttrium-90 radioembolization of isolated hepatic adrenocortical carcinoma metastases with negative surgical pathology. EJNMMI Res 2021; 11:17. [PMID: 33604708 PMCID: PMC7892660 DOI: 10.1186/s13550-021-00755-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/01/2021] [Indexed: 12/14/2022] Open
Abstract
Background Adrenocortical carcinoma (ACC) is an uncommon malignancy with an estimated 15,400 new cases annually across the globe. The prognosis is generally poor as the disease is often already advanced at initial diagnosis due to non-specific symptoms. Even for local disease, recurrence after surgical resection is high. Treatment choices for advanced disease include mitotane, chemotherapy, ablation, chemoembolization, radioembolization, and external beam radiotherapy, with varying degrees of efficacy. To the best of our knowledge, there have only been two prior case studies of complete clinical and radiological response of stage 4 disease at 1 year and 2 years after yttrium-90 (90Y) microsphere selective internal radiation therapy (SIRT) of isolated hepatic metastases post-surgery and chemotherapy. Case presentation We present a case of a 58-year-old man with metastatic ACC who was treated with 90Y resin microsphere (SIR-spheres) for local control of liver metastases leading to a surgically proven negative pathology after partial hepatectomy 7 months after SIRT. The patient was initially diagnosed with stage 1 ACC that progressed 6 years later to stage 4 disease with new liver metastases that were deemed unresectable at an outside institution. After review of the case at multidisciplinary tumor board, he was referred for liver directed therapy for local tumor control. Angiographic workup demonstrated partial extrahepatic supply to the tumors from the right inferior phrenic artery, which was successfully embolized on the day of SIRT for flow redistribution. As the patient was being treated with mitotane that suppresses steroid production, he developed post-SIRT adrenal crisis, which was successfully controlled with steroids, highlighting the need for pre SIRT stress dose steroids. Conclusions This case continues to add to the literature supporting 90Y radioembolization as an effective treatment for isolated hepatic ACC metastases. Our case is the first to demonstrate surgically proven negative pathology after radioembolization. Further prospective study is warranted to better establish efficacy as well as safety of SIRT for ACC liver metastases.
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Affiliation(s)
- Sen Lu
- Department of Diagnostic and Interventional Radiology, University of South Florida, 2 Tampa General Circle, STC 7028, Tampa, FL, 33606, USA.
| | - Jasreman Dhillon
- Department of Pathology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Julie Hallanger Johnson
- Department of Endocrinology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Ghassan El-Haddad
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
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Solak M, Kraljević I, Zibar Tomšić K, Kaštelan M, Kakarigi L, Kaštelan D. Neutrophil-Lymphocyte Ratio as a Prognostic Marker in Adrenocortical Carcinoma. Endocr Res 2021; 46:74-79. [PMID: 33416409 DOI: 10.1080/07435800.2020.1870234] [Citation(s) in RCA: 6] [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] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of the present study was to analyze the impact of the neutrophil-lymphocyte ratio (NLR) on the long-term outcomes of patients with adrenocortical carcinoma (ACC). METHODS This retrospective, single-institution study included 48 patients with the diagnosis of ACC. The primary outcomes of the study were differences in overall survival (OS) and disease-specific survival (DSS) with respect to the NLR level. RESULTS Patients with ENSAT stage IV had higher levels of NLR compared to those with ENSAT stage I-III (5.7 (1.6-12.5) vs 3.3 (1.3-11); p = .01). A higher NLR was also observed among patients with cortisol-secreting tumors (4.6 (1.7-12.5) vs 2.8 (1.3-10.3); p = .003) and those with Ki-67 index >10% (4.3 (1.3-12.5) vs 2.6 (1.6-11.0); p = .005). With respect to survival, the univariate analysis revealed worse ACC-related survival (p = .02) and OS (p = .004) in patients with NLR >3.9 than in those with NLR ≤3.9. In addition, patients with NLR >3.9 had a higher Weiss score (p = .046), a higher Ki-67 index (p = .006) and a higher disease stage (p = .01) compared to patients with NLR ≤3.9. No differences between the groups were observed regarding excess glucocorticoid secretion. CONCLUSION The study demonstrated that a higher NLR level in ACC patients was associated with unfavorable outcomes in terms of DSS and OS. These results indicate that NLR might be used as an additional marker in ACC risk stratification and identification of patients with the most adverse prognosis.
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Affiliation(s)
- Mirsala Solak
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ivana Kraljević
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Karin Zibar Tomšić
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marko Kaštelan
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Luka Kakarigi
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Kaštelan
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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A computational drug repositioning method applied to rare diseases: Adrenocortical carcinoma. Sci Rep 2020; 10:8846. [PMID: 32483162 PMCID: PMC7264316 DOI: 10.1038/s41598-020-65658-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/08/2020] [Indexed: 01/12/2023] Open
Abstract
Rare or orphan diseases affect only small populations, thereby limiting the economic incentive for the drug development process, often resulting in a lack of progress towards treatment. Drug repositioning is a promising approach in these cases, due to its low cost. In this approach, one attempts to identify new purposes for existing drugs that have already been developed and approved for use. By applying the process of drug repositioning to identify novel treatments for rare diseases, we can overcome the lack of economic incentives and make concrete progress towards new therapies. Adrenocortical Carcinoma (ACC) is a rare disease with no practical and definitive therapeutic approach. We apply Heter-LP, a new method of drug repositioning, to suggest novel therapeutic avenues for ACC. Our analysis identifies innovative putative drug-disease, drug-target, and disease-target relationships for ACC, which include Cosyntropin (drug) and DHCR7, IGF1R, MC1R, MAP3K3, TOP2A (protein targets). When results are analyzed using all available information, a number of novel predicted associations related to ACC appear to be valid according to current knowledge. We expect the predicted relations will be useful for drug repositioning in ACC since the resulting ranked lists of drugs and protein targets can be used to expedite the necessary clinical processes.
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Brown TC, Nicolson NG, Man J, Gibson CE, Stenman A, Juhlin CC, Korah R, Carling T. Recurrent Amplification of the Osmotic Stress Transcription Factor NFAT5 in Adrenocortical Carcinoma. J Endocr Soc 2020; 4:bvaa060. [PMID: 32587934 PMCID: PMC7304660 DOI: 10.1210/jendso/bvaa060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Tumorigenesis requires mitigation of osmotic stress and the transcription factor nuclear factor of activated T cells 5 (NFAT5) coordinates this response by inducing transcellular transport of ions and osmolytes. NFAT5 modulates in vitro behavior in several cancer types, but a potential role of NFAT5 in adrenocortical carcinoma (ACC) has not been studied. A discovery cohort of 28 ACCs was selected for analysis. Coverage depth analysis of whole-exome sequencing reads assessed NFAT5 copy number alterations in 19 ACCs. Quantitative real-time PCR measured NFAT5 mRNA expression levels in 11 ACCs and 23 adrenocortical adenomas. Immunohistochemistry investigated protein expression in representative adrenal samples. The Cancer Genome Atlas database was analyzed to corroborate NFAT5 findings from the discovery cohort and to test whether NFAT5 expression correlated with ion/osmolyte channel and regulatory protein expression patterns in ACC. NFAT5 was amplified in 10 ACCs (52.6%) and clustered in the top 6% of all amplified genes. mRNA expression levels were 5-fold higher compared with adrenocortical adenomas (P < 0.0001) and NFAT5 overexpression had a sensitivity and specificity of 81.8% and 82.7%, respectively, for malignancy. Increased protein expression and nuclear localization occurred in representative ACCs. The Cancer Genome Atlas analysis demonstrated concomitant NFAT5 amplification and overexpression (P < 0.0001) that correlated with increased expression of sodium/myo-inositol transporter SLC5A3 (r2 = 0.237, P < 0.0001) and 14 other regulatory proteins (P < 0.05) previously shown to interact with NFAT5. Amplification and overexpression of NFAT5 and associated osmotic stress response related genes may play an important role adrenocortical tumorigenesis.
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Affiliation(s)
- Taylor C Brown
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Norman G Nicolson
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, Connecticut
| | - Jianliang Man
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, Connecticut
| | - Courtney E Gibson
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, Connecticut
| | - Adam Stenman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Reju Korah
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, Connecticut
| | - Tobias Carling
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, Connecticut
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Shimokihara K, Kawahara T, Mochizuki T, Morinaga R, Izumi K, Sanjyo H, Nakaigawa N, Yao M, Otani M, Uemura H. Spontaneous adrenal hemorrhage with dehydroepiandrosterone-sulfate elevation in a patient with suspected adrenal cortical carcinoma. IJU Case Rep 2019; 2:102-104. [PMID: 32743385 PMCID: PMC7292189 DOI: 10.1002/iju5.12053] [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: 11/09/2018] [Accepted: 02/04/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Spontaneous adrenal hemorrhage is a relatively rare disease that is sometimes difficult to differentiate from adrenal cortical carcinoma. We herein report a case of spontaneous adrenal hemorrhage with dehydroepiandrosterone‐sulfate elevation. Case presentation The patient was a 78‐year‐old man with an adrenal tumor that had increased in size to 42 mm. With the exception of an elevated dehydroepiandrosterone‐sulfate level (2281 ng/mL), the results of a hormone analysis were almost normal. Laparoscopic adrenal tumor resection was performed. The pathological diagnosis was adrenal hematoma. Conclusion We reported a case of spontaneous adrenal hemorrhage in a patient with dehydroepiandrosterone‐sulfate elevation.
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Affiliation(s)
- Kota Shimokihara
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Taku Mochizuki
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Ryota Morinaga
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Koji Izumi
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Hiroyuki Sanjyo
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Noboru Nakaigawa
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Masahiro Yao
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Masako Otani
- Division of Diagnostic Pathology Yokohama City University Medical Center Yokohama Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
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10
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Brown TC, Murtha TD, Rubinstein JC, Korah R, Carling T. SLC12A7 alters adrenocortical carcinoma cell adhesion properties to promote an aggressive invasive behavior. Cell Commun Signal 2018; 16:27. [PMID: 29884238 PMCID: PMC5994064 DOI: 10.1186/s12964-018-0243-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/30/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Altered expression of Solute Carrier Family 12 Member 7 (SLC12A7) is implicated to promote malignant behavior in multiple cancer types through an incompletely understood mechanism. Recent studies have shown recurrent gene amplifications and overexpression of SLC12A7 in adrenocortical carcinoma (ACC). The potential mechanistic effect(s) of SLC12A7 amplifications in portending an aggressive behavior in ACC has not been previously studied and is investigated here using two established ACC cell lines, SW-13 and NCI-H295R. METHODS SW-13 cells, which express negligible amounts of SLC12A7, were enforced to express SLC12A7 constitutively, while RNAi gene silencing was performed in NCI-H295R cells, which have robust endogenous expression of SLC12A7. In vitro studies tested the outcomes of experimental alterations in SLC12A7 expression on malignant characteristics, including cell viability, growth, colony formation potential, motility, invasive capacity, adhesion and detachment kinetics, and cell membrane organization. Further, potential alterations in transcription regulation downstream to induced SLC12A7 overexpression was explored using targeted transcription factor expression arrays. RESULTS Enforced SLC12A7 overexpression in SW-13 cells robustly promoted motility and invasive characteristics (p < 0.05) without significantly altering cell viability, growth, or colony formation potential. SLC12A7 overexpression also significantly increased rates of cellular attachment and detachment turnover (p < 0.05), potentially propelled by increased filopodia formation and/or Ezrin interaction. In contrast, RNAi gene silencing of SLC12A7 stymied cell attachment strength as well as migration and invasion capacity in NCI-H295R cells. Transcription factor expression analysis identified multiple signally pathways potentially affected by SLC12A7 overexpression, including osmotic stress, bone morphogenetic protein, and Hippo signaling pathways. CONCLUSIONS Amplification of SLC12A7 observed in ACCs is shown here, in vitro, to exacerbate the malignant behavior of ACC cells by promoting invasive capacities, possibly mediated by alterations in multiple signaling pathways, including the osmotic stress pathway.
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Affiliation(s)
- Taylor C Brown
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA.,Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA
| | - Timothy D Murtha
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA.,Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA
| | - Jill C Rubinstein
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA.,Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA
| | - Reju Korah
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA.,Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA
| | - Tobias Carling
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA. .,Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, 333 Cedar Street, TMP FMB130A, P.O. Box 208062, New Haven, CT, 06520, USA.
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11
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Mochizuki T, Kawahara T, Takamoto D, Makiyama K, Hattori Y, Teranishi JI, Miyoshi Y, Yumura Y, Yao M, Uemura H. The neutrophil-to-lymphocyte ratio (NLR) predicts adrenocortical carcinoma and is correlated with the prognosis. BMC Urol 2017; 17:49. [PMID: 28662713 PMCID: PMC5490233 DOI: 10.1186/s12894-017-0240-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) is reported as a biomarker for some solid malignant diseases. Thus far, however, no reports of the relationship between the NLR and adrenal tumors have been published. We analyzed the utility of the preoperative NLR as a biomarker for predicting the prognosis or diagnosis of malignant disease. Methods A total of 59 patients with adrenal tumors (13 cases of malignant disease and 46 with benign disease) were analyzed in this study from February 2004 to June 2015 at our institute. The NLR was obtained just before adrenalectomy. The diagnosis of adrenal tumor was confirmed by a pathological examination of surgical specimens. Results The NLR in malignant adrenal tumor specimens was significantly higher than in non-malignant specimens (p = 0.028). Adrenocortical carcinoma (ACC) showed the highest NLR among all adrenal tumors. In ACC, the higher NLR group (NLR ≥ 5) showed a significantly poorer overall survival than the lower NLR group (NLR < 5) (p = 0.032). Conclusions In adrenal tumors, a higher NLR indicates a higher incidence of malignancy. The NLR might be a new biomarker for predicting the prognosis of adrenal tumor patients.
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Affiliation(s)
- Taku Mochizuki
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan. .,Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
| | - Daiji Takamoto
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yusuke Hattori
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Jun-Ichi Teranishi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Yasuhide Miyoshi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Yasushi Yumura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
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12
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Murtha TD, Brown TC, Rubinstein JC, Haglund F, Juhlin CC, Larsson C, Korah R, Carling T. Overexpression of cytochrome P450 2A6 in adrenocortical carcinoma. Surgery 2017; 161:1667-1674. [PMID: 28073588 PMCID: PMC7301492 DOI: 10.1016/j.surg.2016.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/08/2016] [Accepted: 11/22/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cytochrome P450-mediated metabolism of chemotherapeutic agents contributes to chemotherapy resistance in multiple malignancies. Adrenocortical carcinoma is known to have a poor response to adjuvant therapies; however, the mechanism remains unknown. Recent comprehensive genetic analyses of adrenocortical carcinomas demonstrated recurrent copy number gains in multiple cytochrome P450 genes prompting investigation into whether cytochrome P450 overexpression potentiates adrenocortical carcinoma chemoresistance. METHODS We determined the expression patterns of 6 cytochrome P450 genes (CYP2A6, CYP2A7, CYP2A13, CYP2B6, CYP2S1, and CYP4F2) predicted to be amplified in adrenocortical carcinoma (n = 29) relative to normal adrenal cortex (n = 10). Gene copy numbers were determined with the TaqMan copy number assay. Gene silencing was performed via small interfering RNA (siRNA) in the adrenocortical carcinoma cell line NCI-H295R and treated with mitotane and cisplatin. RESULTS Of the 6 cytochrome P450 genes tested, CYP2A6 was overexpressed with a 55-fold mean increase compared to normal adrenal samples (P < .05). Immunohistochemical analysis confirmed protein overexpression. Copy gains of CYP2A6 were found in 26% (7/27) of adrenocortical carcinoma specimens. Silencing of CYP2A6 in NCI-H295R cells resulted in decreased cell viability and increased chemosensitivity (P < .05). CONCLUSION Frequent upregulation in adrenocortical carcinomas and the reversal of chemoresistance in adrenocortical carcinoma cells via enforced silencing suggest a role for CYP2A6 in adrenocortical malignancy.
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Affiliation(s)
- Timothy D Murtha
- Yale Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, CT
| | - Taylor C Brown
- Yale Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, CT
| | - Jill C Rubinstein
- Yale Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, CT
| | - Felix Haglund
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Catharina Larsson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Reju Korah
- Yale Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, CT
| | - Tobias Carling
- Yale Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, CT.
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13
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Cheng JY, Brown TC, Murtha TD, Stenman A, Juhlin CC, Larsson C, Healy JM, Prasad ML, Knoefel WT, Krieg A, Scholl UI, Korah R, Carling T. A novel FOXO1-mediated dedifferentiation blocking role for DKK3 in adrenocortical carcinogenesis. BMC Cancer 2017; 17:164. [PMID: 28249601 PMCID: PMC5333434 DOI: 10.1186/s12885-017-3152-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 02/22/2017] [Indexed: 11/17/2022] Open
Abstract
Background Dysregulated WNT signaling dominates adrenocortical malignancies. This study investigates whether silencing of the WNT negative regulator DKK3 (Dickkopf-related protein 3), an implicated adrenocortical differentiation marker and an established tumor suppressor in multiple cancers, allows dedifferentiation of the adrenal cortex. Methods We analyzed the expression and regulation of DKK3 in human adrenocortical carcinoma (ACC) by qRT-PCR, immunofluorescence, promoter methylation assay, and copy number analysis. We also conducted functional studies on ACC cell lines, NCI-H295R and SW-13, using siRNAs and enforced DKK3 expression to test DKK3’s role in blocking dedifferentiation of adrenal cortex. Results While robust expression was observed in normal adrenal cortex, DKK3 was down-regulated in the majority (>75%) of adrenocortical carcinomas (ACC) tested. Both genetic (gene copy loss) and epigenetic (promoter methylation) events were found to play significant roles in DKK3 down-regulation in ACCs. While NCI-H295R cells harboring β-catenin activating mutations failed to respond to DKK3 silencing, SW-13 cells showed increased motility and reduced clonal growth. Conversely, exogenously added DKK3 also increased motility of SW-13 cells without influencing their growth. Enforced over-expression of DKK3 in SW-13 cells resulted in slower cell growth by an extension of G1 phase, promoted survival of microcolonies, and resulted in significant impairment of migratory and invasive behaviors, largely attributable to modified cell adhesions and adhesion kinetics. DKK3-over-expressing cells also showed increased expression of Forkhead Box Protein O1 (FOXO1) transcription factor, RNAi silencing of which partially restored the migratory proficiency of cells without interfering with their viability. Conclusions DKK3 suppression observed in ACCs and the effects of manipulation of DKK3 expression in ACC cell lines suggest a FOXO1-mediated differentiation-promoting role for DKK3 in the adrenal cortex, silencing of which may allow adrenocortical dedifferentiation and malignancy. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3152-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joyce Y Cheng
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT, USA
| | - Taylor C Brown
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT, USA
| | - Timothy D Murtha
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT, USA
| | - Adam Stenman
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, CCK, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, CCK, Stockholm, Sweden
| | - Catharina Larsson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, CCK, Stockholm, Sweden
| | - James M Healy
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT, USA
| | - Manju L Prasad
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Wolfram T Knoefel
- Department of Surgery, Medical School, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andreas Krieg
- Department of Surgery, Medical School, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ute I Scholl
- Department of Nephrology, Medical School, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Reju Korah
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT, USA
| | - Tobias Carling
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT, USA. .,Department of Surgery, Yale University School of Medicine, 333 Cedar Street, FMB130A, New Haven, CT, 06520, USA.
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14
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Thompson LH, Nordenström E, Almquist M, Jacobsson H, Bergenfelz A. Risk factors for complications after adrenalectomy: results from a comprehensive national database. Langenbecks Arch Surg 2016; 402:315-322. [PMID: 27896436 PMCID: PMC5346413 DOI: 10.1007/s00423-016-1535-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/14/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Most knowledge regarding outcome after adrenal surgery stems from retrospective studies reported by highly specialized centres. The aim of this study was to report a national experience of adrenalectomy with particular attention to predictive factors for postoperative complications, conversion from endoscopic to open surgery and length of hospital stay. METHODS Adrenalectomies reported in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009-2014 were included. Risk factors for complications, conversion and hospital stay >3 days were assessed using univariable and multivariable logistic regression analysis. RESULTS There were 659 operations. Endoscopic adrenalectomy was performed in 513 (77.8%) operations and almost half of these were robotic assisted. The median length of hospital stay was 3 (range 1-30) days. There was no 30-day mortality. In 43 (6.6%) patients, at least one complication was registered. The only factor associated with complications in multivariable analysis was conversion to open surgery odds ratio (OR) 3.61 (95% confidence interval 1.07 to 12.12). The risk for conversion was associated with tumour size OR 1.03 (1.00 to 1.06) and with malignancy on histopathology OR 8.33 (2.12 to 32.07). Length of hospital stay increased in patients with operation of bilateral tumours OR 3.13, left-sided tumours OR 1.98, hyper secretion of catecholamines OR 2.32, conversion to open surgery OR 42.05 and open surgery OR 115.18. CONCLUSIONS The present study shows that endoscopic surgery is widely used. Complications were associated with conversion and the risk for conversion was associated with tumour size and malignant tumour. Hospital stay was short.
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Affiliation(s)
| | - Erik Nordenström
- Department of Surgery, Skåne University Hospital, 22185, Lund, Sweden
| | - Martin Almquist
- Department of Surgery, Skåne University Hospital, 22185, Lund, Sweden
| | - Helene Jacobsson
- Research and Development Centre Skåne, Skåne University Hospital, 22185, Lund, Sweden
| | - Anders Bergenfelz
- Department of Surgery, Skåne University Hospital, 22185, Lund, Sweden
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15
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Murtha TD, Korah R, Carling T. Suppression of cytochrome P450 4B1: An early event in adrenocortical tumorigenesis. Surgery 2016; 161:257-263. [PMID: 27865598 DOI: 10.1016/j.surg.2016.04.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/30/2016] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adrenocortical carcinoma is a rare neoplasm with a poor prognosis. Conversely, adrenocortical adenomas are common and benign. Despite their shared histologic origin, little evidence exists to suggest that adrenocortical adenoma arises from adrenocortical carcinoma. Recent genetic analyses of adrenocortical carcinoma have shown recurrent gene copy deletion of CYP4B1, a cytochrome P450 isozyme. This study investigates a potential role for CYP4B1 in modulating adrenocortical tumorigenesis and/or conferring chemoresistance to adrenocortical carcinomas. METHODS Using TaqMan, real-time quantitative polymerase chain reaction techniques, we investigated CYP4B1 expression in normal adrenal cortex (n = 10), histologically confirmed adrenocortical adenomas (n = 10), and adrenocortical carcinomas (n = 10). Adrenocortical carcinoma cell lines were enforced to express CYP4B1, and effects on cell death and enhanced mitotane and cisplatin sensitivity were tested. RESULTS Gene expression analyses demonstrated suppression of CYP4B1 in 100% of both the adrenocortical adenomas (10/10) and adrenocortical carcinomas (10/10) tested. Average relative expression of CYP4B1 was decreased at 0.19 (0.01-0.50; P < .01) in adrenocortical adenomas and nearly absent in adrenocortical carcinomas (0.01; 0.00-0.05; P < .01). Protein expression correlated with mRNA expression. Ectopic expression of CYP4B1 promoted cytotoxicity and increased chemosensitivity in adrenocortical carcinoma cell lines. CONCLUSION CYP4B1 is silenced in both benign and malignant adrenocortical tumors and may contribute to tumorigenesis and chemoresistance. Sensitization of adrenocortical carcinoma cells engineered to overexpress CYP4B1 further supports this notion.
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Affiliation(s)
- Timothy D Murtha
- Department of Surgery and Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, CT
| | - Reju Korah
- Department of Surgery and Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, CT
| | - Tobias Carling
- Department of Surgery and Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, CT.
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16
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Wang Y, Zhou F, Pan H, Jin B. Adrenal cortical carcinoma with tumor thrombus extension into the right atrium: A case report. Oncol Lett 2016; 11:3987-3991. [PMID: 27313728 PMCID: PMC4888244 DOI: 10.3892/ol.2016.4502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/01/2016] [Indexed: 11/06/2022] Open
Abstract
Adrenal cortical carcinoma (ACC) is a rare aggressive malignant tumor associated with a poor prognosis. Patients with ACC usually present with abnormal hormone secretion, tumor growth or encroachment on the surrounding viscera. An early diagnosis of ACC is considered challenging. The present study reports a case of ACC with tumor thrombus extension into the inferior vena cava and right atrium. A 33-year-old male patient exhibited symptoms of gynecomastia and abdominal distention, which were due to the abnormal hormone secretion levels and to the presence of a large mass in the right adrenal gland. An en bloc resection of the tumor was the selected treatment option. Extirpation of the tumor thrombus was performed by means of extracorporeal circulation. No signs of metastasis or recurrence were identified at the 1-month follow-up.
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Affiliation(s)
- Yimin Wang
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Feng Zhou
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Hao Pan
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Baiye Jin
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Calissendorff J, Calissendorff F, Falhammar H. Adrenocortical cancer: mortality, hormone secretion, proliferation and urine steroids - experience from a single centre spanning three decades. BMC Endocr Disord 2016; 16:15. [PMID: 26984275 PMCID: PMC4794924 DOI: 10.1186/s12902-016-0095-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 03/10/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare malignant disease with a poor prognosis. Our aims were to study survival and to explore prognostic markers. METHODS We retrospectively investigated the medical records of all 50 ACC patients at a single centre diagnosed between 1985 and 2012 and followed them up until 31/12/2014. RESULTS Of this cohort, twenty six (52 %) were females. Adrenalectomy was performed in 48 patients (96 %), and twenty seven (54 %) were treated with adjuvant cytotoxic agents. The tumor sizes ranged from 6 to 20 cm. Overall survival time was 5.5 years (0.3-19.8), the two and five-year survival was 64 and 40 %, respectively. In ENSAT stage II 25/48 patients had a median survival of 7.0 years (0.7-15.5), in stage III 8/48 this was 1.9 (0.4 - 19.8), and in stage IV 15/48 it was 1.2 (0.3-3.6) years. Seventeen patients (34 %) were still alive at the end of 2014. The total follow-up time was 8.4 (0.3-19.8) years. Cell proliferation measured with Ki-67 had a median value of 15 % (2-80) and the urinary steroid profile was clearly pathologic in 29 of 43 (67 %) tested patients. The proliferation index did not significantly predict mortality (Ki-67 ≤ 10 vs. >10 %, 9.0 vs. 3.2 years, P = 0.0833), but resection margins did (R1 vs. R2, P = 0.0066; R0 vs. R2, P < 0.0001). The urinary steroid profile did not predict mortality (normal vs. pathologic urine profile: median survival 6.6 vs. 3.3 years, P = 0.261). CONCLUSIONS The prognosis was generally poor and macroscopically positive resection margins resulted in a worse prognosis. However, some patients were still alive many years following primary surgery with no sign of residual disease.
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Affiliation(s)
- Jan Calissendorff
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
- Endocrine Section, VO Internmedicin, Södersjukhuset, Sjukhusbacken 10, 118 83, Stockholm, Sweden.
| | - Freja Calissendorff
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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18
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Brown TC, Juhlin CC, Healy JM, Stenman A, Rubinstein JC, Korah R, Carling T. DNA copy amplification and overexpression of SLC12A7 in adrenocortical carcinoma. Surgery 2015; 159:250-7. [PMID: 26454676 DOI: 10.1016/j.surg.2015.08.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/19/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Overexpression of Solute carrier family 12 member 7 (SLC12A7) promotes tumor aggressiveness in various cancers. Previous studies have identified the 5p15.33 region, containing the SLC12A7 locus, as being amplified frequently in adrenocortical carcinoma (ACC). Copy number amplifications (CNAs) may alter gene expression levels and occur frequently in ACC; however, SLC12A7 gene amplifications or expression levels have not been studied in ACC. METHODS Fifty-five cases of clinically well-characterized ACCs were recruited for this study. Whole-exome sequencing was used to predict CNAs in 19 samples. CNA analysis was performed on an expanded cohort of 26 samples with the use of TaqMan Copy Number Assays. SLC12A7 mRNA expression was analyzed in 32 samples with real-time quantitative polymerase chain reaction and protein expression was assessed by immunohistochemistry. SLC12A7 CNAs and expression patterns were evaluated for correlation with patient and tumor characteristics. RESULTS Whole-exome sequencing and TaqMan Copy Number Assays demonstrated SLC12A7 amplifications in 68.4% and 65.4% of ACCs tested, respectively. Furthermore, SLC12A7 copy gains were associated with increased gene expression (P < .05) and non-functional tumors (P < .05). SLC12A7 gene expression levels were increased in ACCs compared with normal adrenal tissue (P < .05). CONCLUSION SLC12A7 gene amplification and overexpression occurs frequently in ACCs and may represent a novel molecular event associated with ACC.
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Affiliation(s)
- Taylor C Brown
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT
| | - C Christofer Juhlin
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT; Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - James M Healy
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT
| | - Adam Stenman
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jill C Rubinstein
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT
| | - Reju Korah
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT
| | - Tobias Carling
- Department of Surgery & Yale Endocrine Neoplasia Laboratory, Yale University School of Medicine, New Haven, CT.
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19
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Juhlin CC, Goh G, Healy JM, Fonseca AL, Scholl UI, Stenman A, Kunstman JW, Brown TC, Overton JD, Mane SM, Nelson-Williams C, Bäckdahl M, Suttorp AC, Haase M, Choi M, Schlessinger J, Rimm DL, Höög A, Prasad ML, Korah R, Larsson C, Lifton RP, Carling T. Whole-exome sequencing characterizes the landscape of somatic mutations and copy number alterations in adrenocortical carcinoma. J Clin Endocrinol Metab 2015; 100:E493-502. [PMID: 25490274 PMCID: PMC5393505 DOI: 10.1210/jc.2014-3282] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is a rare and lethal malignancy with a poorly defined etiology, and the molecular genetics of ACC are incompletely understood. OBJECTIVE To utilize whole-exome sequencing for genetic characterization of the underlying somatic mutations and copy number alterations present in ACC. DESIGN Screening for somatic mutation events and copy number alterations (CNAs) was performed by comparative analysis of tumors and matched normal samples from 41 patients with ACC. RESULTS In total, 966 nonsynonymous somatic mutations were detected, including 40 tumors with a mean of 16 mutations per sample and one tumor with 314 mutations. Somatic mutations in ACC-associated genes included TP53 (8/41 tumors, 19.5%) and CTNNB1 (4/41, 9.8%). Genes with potential disease-causing mutations included GNAS, NF2, and RB1, and recurrently mutated genes with unknown roles in tumorigenesis comprised CDC27, SCN7A, and SDK1. Recurrent CNAs included amplification at 5p15.33 including TERT (6/41, 14.6%) and homozygous deletion at 22q12.1 including the Wnt repressors ZNRF3 and KREMEN1 (4/41 9.8% and 3/41, 7.3%, respectively). Somatic mutations in ACC-established genes and recurrent ZNRF3 and TERT loci CNAs were mutually exclusive in the majority of cases. Moreover, gene ontology identified Wnt signaling as the most frequently mutated pathway in ACCs. CONCLUSIONS These findings highlight the importance of Wnt pathway dysregulation in ACC and corroborate the finding of homozygous deletion of Wnt repressors ZNRF3 and KREMEN1. Overall, mutations in either TP53 or CTNNB1 as well as focal CNAs at the ZNRF3 or TERT loci denote mutually exclusive events, suggesting separate mechanisms underlying the development of these tumors.
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Affiliation(s)
- C Christofer Juhlin
- Yale Endocrine Neoplasia Laboratory (C.C.J., J.M.H., A.L.F., J.W.K., T.C.B., R.K., T.C.), Yale School of Medicine, New Haven, Connecticut 06520; Department of Surgery (C.C.J., J.M.H., A.L.F., J.W.K., T.C.B., R.K., T.C.), Yale School of Medicine, New Haven, Connecticut, 06520; Department of Genetics (G.G., C.N.W., M.C., R.P.L.), Yale School of Medicine and Howard Hughes Medical Institute, New Haven, Connecticut, 06520; Department of Oncology-Pathology (C.C.J., A.S., A.H., C.L.), Karolinska Institutet, Karolinska University Hospital, CCK, SE-171 76 Stockholm, Sweden; Yale Center for Genome Analysis (JDO, SMM), Orange, Connecticut, 06477; Department of Pathology (D.L.R., M.L.P.), Yale School of Medicine, New Haven, Connecticut, 06520; Department of Pharmacology (J.S.), Yale School of Medicine, New Haven, Connecticut 06520; Department of Molecular Medicine and Surgery (M.B.), Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; Division of Nephrology (U.I.S.), University Hospital Düsseldorf, 40225 Düsseldorf, Germany; Department of Pathology (A.C.S.), University Hospital Düsseldorf, 40225 Düsseldorf, Germany; and Division of Endocrinology and Diabetology (M.H.), University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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20
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Livhits M, Li N, Yeh MW, Harari A. Surgery is associated with improved survival for adrenocortical cancer, even in metastatic disease. Surgery 2014; 156:1531-40; discussion 1540-1. [PMID: 25456949 PMCID: PMC5031479 DOI: 10.1016/j.surg.2014.08.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare but lethal tumor. Predictors of survival include earlier stage at presentation and complete operative resection. We assessed effect of treatment and demographic variables on survival. METHODS ACC cases were abstracted from the California Cancer Registry and Office of Statewide Health Planning and Development (1999-2008). Predictors included patient demographics, comorbidities, tumor size, stage, and treatment (none, surgery, chemotherapy and/or radiation [CRT], and surgery plus CRT). RESULTS We studied 367 patients with median tumor size of 10 cm. At presentation, 37% had localized, 17% had regional, and 46% had metastatic disease. Median survival was 1.7 years (7.4 years local, 2.6 years regional, and 0.3 years metastatic, P < .0001). One-year and 5-year survival was: 92%/62% (local); 73%/39% (regional); and 24%/7% (metastatic). Increased age (hazard ratio [HR] 1.16) and Cushing's syndrome (HR 1.66) worsened survival (P < .05). Low socioeconomic status worsened survival in local and regional disease (P < .05). In multivariable regression, both surgery (regional HR 0.13; metastatic HR 0.52) and surgery plus CRT (regional HR 0.15; metastatic HR 0.31) improved survival compared with no treatment (P < .02). CONCLUSION In ACC, surgery is associated with improved survival, even in metastatic disease. Surgery should be considered for select patients as part of multimodality treatment.
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Affiliation(s)
- Masha Livhits
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Ning Li
- Department of Biomathematics, University of California, Los Angeles, Los Angeles, CA
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Avital Harari
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA.
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Røe OD, Oppegaard PA, Revheim ME, Svindland A. Adrenocortical carcinoma mimicking lung cancer and responding to vinorelbine/carboplatin and pemetrexed/carboplatin. BMJ Case Rep 2014; 2014:bcr-2014-206225. [PMID: 25391823 DOI: 10.1136/bcr-2014-206225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenocortical carcinoma is an aggressive cancer, with an incidence of 0.5-2 per million. We present a case of adrenocortical carcinoma with all the clinical and partly immunohistochemical features of disseminated undifferentiated lung cancer, and 'accidentally' treated as such. Four cycles of carboplatin-vinorelbine conferred partial response in the adrenal, lung and disappearance of a 2 cm subcutaneous iliac nodule that had appeared suddenly before the first course. Owing to progression, four cycles of carboplatin-pemetrexed were administered inducing partial response and then stable disease for an additional 12 months. As fluoro-d-glucose (FDG)-positron emission tomography (PET) only showed activity in the adrenal, laparoscopic adrenalectomy was performed. Three months later FDG-PET revealed a lung nodule unresponsive to carboplatin-pemetrexed, removed by wedge resection. Finally, re-evaluation by a tertiary centre confirmed adrenocortical carcinoma with Ki67-50% in the adrenal and the lung. The patient is alive and tumour free almost 3.5 years after retrospective diagnosis of metastatic adrenocortical cancer.
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Affiliation(s)
- Oluf Dimitri Røe
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway Cancer Clinic, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Aud Svindland
- Department of Pathology, Oslo University Hospital, Oslo, Norway
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[Clinicopathologic characteristics and prognosis of patients with adrenocortical carcinoma]. Nihon Hinyokika Gakkai Zasshi 2014; 105:79-84. [PMID: 25158548 DOI: 10.5980/jpnjurol.105.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is a rare condition associated with poor prognosis. This study aimed to evaluate the clinicopathologic characteristics and prognosis of 7 patients with ACC. PATIENTS AND METHODS The clinicopathologic characteristics, treatment, and survival of 7 patients with pathologically confirmed ACC treated at our institution between January 2002 and December 2012 were retrospectively examined. RESULTS The study cohort comprised 4 male and 3 female patients (median age at diagnosis, 63 years [range, 36-71 years]). The median tumor size was 7.0 cm (range, 4.0-13.0 cm), and the median follow-up duration was 22 months (range, 9-107 months). One patient had stage I ACC, 4 had stage III, and 2 showed metastasis. The patient with stage I disease underwent laparoscopic adrenorectomy and those with stage III disease underwent adrenorectomy with the excision of adjacent organs. Four of these 5 patients are alive without recurrence at a median of 55 months (range, 22-107 months) after surgery. Of the 2 patients with metastases, 1 received combined chemotherapy with etoposide, adriamycin, and cisplatin plus mitotane without surgical resection but died 19 months later, and the other, with a solitary lung metastasis, underwent adrenorectomy and metastatectomy followed by adjuvant treatment with mitotane and is alive without recurrence at 9 months after treatment. The 3-year cause-specific survival rate was 56%. CONCLUSIONS Patients with advanced-stage tumors showed long-term survival with complete tumor resection at diagnosis; hence, this seems to be most beneficial treatment option for patients with ACC.
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Siosaki MD, Pelafsky L, Fonseca Siosaki AT, Garcia LR. Adrenocortical Carcinoma in an Adult: Eight Months without Recurrence after Resection and Adjuvant Chemotherapy. Case Rep Oncol 2014; 7:222-7. [PMID: 24803899 PMCID: PMC4000306 DOI: 10.1159/000362161] [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: 11/19/2022] Open
Abstract
Adrenocortical carcinoma is a rare, aggressive malignancy that features a correspondingly poor prognosis. The disease accounts for 0.2% of all malignancies and despite multimodal therapies, its prognosis remains poor, with a mean survival of <30 months. This paper reports on a patient submitted to surgical resection and adjuvant chemotherapy for adrenocortical carcinoma with an ongoing follow-up of 8 months after surgery and no signs of recurrence.
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Affiliation(s)
| | - Leonardo Pelafsky
- Surgical Oncology Department, Hospital Estadual Bauru, Bauru, Brazil
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24
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Glover AR, Ip JCY, Zhao JT, Soon PSH, Robinson BG, Sidhu SB. Current management options for recurrent adrenocortical carcinoma. Onco Targets Ther 2013; 6:635-43. [PMID: 23776337 PMCID: PMC3681406 DOI: 10.2147/ott.s34956] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adrenal cortical carcinoma (ACC) is a rare cancer that poses a number of management challenges due to the limited number of effective systemic treatments. Complete surgical resection offers the best chance of long-term survival. However, despite complete resection, ACC is associated with high recurrence rates. This review will discuss the management of recurrent ACC in adults following complete surgical resection. Management should take place in a specialist center and treatment decisions must consider the individual tumor biology of each case of recurrence. Given the fact that ACC commonly recurs, management to prevent recurrence should be considered from initial diagnosis with the use of adjuvant mitotane. Close follow up with clinical examination and imaging is important for early detection of recurrent disease. Locoregional recurrence may be isolated, and repeat surgical resection should be considered along with mitotane. The use of radiotherapy in ACC remains controversial. Systemic recurrence most often involves liver, pulmonary, and bone metastasis and is usually managed with mitotane, with or without combination chemotherapy. There is a limited role for surgical resection in systemic recurrence in selected patients. In all patients with recurrent disease, control of excessive hormone production is an important part of management. Despite intensive management of recurrent ACC, treatment failure is common and the use of clinical trials and novel treatment is an important part of management.
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Affiliation(s)
- Anthony R Glover
- Kolling Institute of Medical Research, Cancer Genetics Laboratory, Royal North Shore Hospital and University of Sydney, St Leonards, Australia
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25
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Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 2013; 184:216-20. [PMID: 23664532 DOI: 10.1016/j.jss.2013.04.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/30/2013] [Accepted: 04/05/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although the existing literature suggests that laparoscopic adrenalectomy may be associated with less postoperative morbidity than open adrenalectomy, a comparison of the two approaches has not been published using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data. The objective of our analysis was to compare the 30-d outcomes after laparoscopic versus open adrenalectomy using this data source. METHODS The ACS-NSQIP Participant User Files for 2005-2010 were used for this retrospective analysis, which included all patients with (1) a primary Current Procedural Terminology code for open or laparoscopic adrenalectomy and (2) a postoperative International Classification of Diseases, Ninth Revision (ICD-9) code for adrenal gland pathology. Primary outcomes were 30-d postoperative mortality, overall complication rate, and length of postoperative hospitalization. The association between surgical approach and primary outcomes were determined after adjusting for a comprehensive array of patient- and procedure-related factors. RESULTS A total of 3100 patients were included for analysis (644 undergoing open versus 2456 undergoing laparoscopic adrenalectomy). Patients undergoing a laparoscopic procedure had significantly lower postoperative morbidity and shorter length of stay than patients undergoing an open procedure after adjustment for patient- and procedure-related factors. Similar findings were demonstrated for all indications, including malignancy. CONCLUSIONS To our knowledge, the present study represents the largest comparison to date of laparoscopic versus open adrenalectomy. Our findings suggest that the laparoscopic approach is associated with sizeable reductions in postoperative morbidity and length of postoperative hospitalization.
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