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Karaosmanoglu AD, Uysal A, Arslan S, Sokmensuer C, Leblebici CB, Akata D, Ozmen MN, Karcaaltincaba M. Can we differentiate neoplastic and non-neoplastic spontaneous adrenal bleeding? Imaging findings with radiopathologic correlation. Abdom Radiol (NY) 2021; 46:1091-1102. [PMID: 32940758 DOI: 10.1007/s00261-020-02750-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 02/02/2023]
Abstract
Spontaneous adrenal bleeding is a rare clinical event with non-specific clinical features. Life-threatening bleeding in the adrenal glands may be promptly diagnosed with imaging. Computed tomography (CT) is generally the first imaging modality to be used in these patients. However, in the acute phase of bleeding, it may be difficult to detect the underlying mass from the large hematoma. In these patients, additional imaging studies such as magnetic resonance imaging or positron emission tomography/CT may be utilized to rule out a neoplastic mass as the source of bleeding. In patients where an underlying neoplastic mass could not be identified at the time of initial diagnosis, follow-up imaging may be helpful after the acute phase subsides.
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2
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Ma C, Xiong J, Su H, Li H. The underlying molecular mechanism and drugs for treatment in adrenal cortical carcinoma. Int J Med Sci 2021; 18:3026-3038. [PMID: 34220331 PMCID: PMC8241782 DOI: 10.7150/ijms.60261] [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: 03/12/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: The study aimed to predict and explore the possible clinical value and mechanism of genetic markers in adrenal cortical carcinoma using a bioinformatics analysis method. Methods: The RNA-seqs and miRNAs data were downloaded from TCGA database to identify the differentially expressed genes and differentially expressed miRNAs. The hub-genes were screened by building protein-protein interaction sub-networks with 12 topological analysis methods. We conducted the receiver operating characteristic curve to elevate the diagnostic value of hub-genes in distinguishing the death and alive groups. The survival analysis of hub-genes and key miRNAs were conducted using Kaplan-Meier curves. Furthermore, most significant small molecules were identified as therapeutic candidates for adrenal cortical carcinoma by the CMap analysis. Results: Compared to survival group, we found 475 up-regulated genes and 354 genes and the key pathways leading to the death of different ACC individual patients. Then we used 12 topological analysis methods to found the most possible 22 hub-genes. Among these hub-genes, nine hub-genes (C3, CXCL5, CX3CR1, GRM8, HCAR2, HTR1B, SUCNR1, PTGER3 and SSTR1) could be used to distinguish the death and survival groups for patients. We also revealed that mRNA expressions of 12 genes (C3, CXCL8, CX3CR1, GNAT3, GNGT1, GRM8, HCAR2, HTR1B, HTR1D, PTGER3, SSTR1 and SUCNR1) and four key miRNAs (hsa-mir-330, hsa-mir-489, hsa-mir-508 and hsa-mir-513b) were related to survival. Three most small molecules were identified (H-9, AZ-628 and phensuximide) as potential therapeutic drugs for adrenal cortical carcinoma. Conclusion: The hub-genes expression was significant useful in adrenal cortical carcinoma, provide new diagnostic, prognosis and therapeutic approaches for adrenal cortical carcinoma. Furthermore, we also explore the possible miRNAs involved in regulation of hub-genes.
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Affiliation(s)
- Chengquan Ma
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian Xiong
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Su
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongjun Li
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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3
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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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4
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Abstract
In the last three decades, endoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal diseases. Gagner et al., first reported in 1992, the lateral trans-abdominal laparoscopic approach to adrenalectomy. Afterwards, several retrospective and comparative studies addressed the advantages of minimally invasive adrenalectomy specifically consistent in less postoperative pain, improved patients' satisfaction, shorter hospital stay and recovery time when compared to open adrenalectomy. The lateral transabdominal approach to the adrenals is currently one of the most widely used, since it allows an optimal comprehensive view of the adrenal region and surrounding structures, and provides and adequate working space. On the other hand, from a technical point of view, essential requirements for a successful laparoscopic adrenalectomy are an appropriate knowledge of retroperitoneal anatomy, a gentle tissue manipulation and a precise haemostasis technique in order to identify appropriately the structures of interest and avoid the troublesome 'oozing' that could complicate the surgical procedure.
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Affiliation(s)
- Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela De Crea
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Rocco Bellantone
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
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5
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Pérez-Ardila MA, Naranjo-Millán J, Giral H, Mugnier J, Altamar H. Late recurrence of adrenocortical carcinoma and metastatic disease. Case report. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n3.70507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Adrenocortical carcinoma (ACC) is a malignancy with an annual incidence of 0.72 cases per million people. It is a rare tumor that is associated with high mortality in late stages, as well as with a 5-year survival of 13% in stage IV patients, and 61% in stage II lesions. Nevertheless, tumor recurrence occurs in up to 54% at 23 months with predominance of locoregional involvement, being striking the late presentation of tumor recurrence with extensive involvement.Case presentation: This is the case of a 52-year-old male patient with a history of resection of an ACC of 6cm five years earlier, who was admitted for decompensated heart failure. A chest x-ray was taken suggesting metastasis. After conducting biochemical studies and CT scan of the abdomen, ACC with metastases to liver and lung was diagnosed. The patient decided not to receive palliative chemotherapy.Conclusion: This unfortunate outcome is related to the lack of follow-up after the initial procedure. Clinical, hormonal, and imaging evaluation is recommended every 3 months for 2 years, and then at least every 6 months.
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6
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Lima D, Inaba J, Clarindo Lopes L, Calaça GN, Los Weinert P, Lenzi Fogaça R, Ferreira de Moura J, Magalhães Alvarenga L, Cavalcante de Figueiredo B, Wohnrath K, Andrade Pessôa C. Label-free impedimetric immunosensor based on arginine-functionalized gold nanoparticles for detection of DHEAS, a biomarker of pediatric adrenocortical carcinoma. Biosens Bioelectron 2019; 133:86-93. [PMID: 30909017 DOI: 10.1016/j.bios.2019.02.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/23/2019] [Indexed: 12/17/2022]
Abstract
Pediatric adrenocortical carcinoma (pACC) is a rare and aggressive malignancy of high occurrence in Southern Brazil. pACC is characterized by the usual overproduction of dehydroepiandrosterone sulfate (DHEAS), whose detection in serum or plasma can be effective to the early diagnosis of the disease. Therefore, the present paper reports, for the first time, the construction and application of a label-free impedimetric immunosensor to detect DHEAS, which was based on the modification of an oxidized glassy carbon electrode with arginine-functionalized gold nanoparticles (AuNPs-ARG) and anti-DHEA IgM antibodies (ox-GCE/AuNPs-ARG/IgM). AuNPs-ARG was synthesized by a green route, and characterized by UV-VIS spectroscopy, FTIR, TEM, DLS, and XRD. The construction of ox-GCE/AuNPs-ARG/IgM was optimized through factorial design and response surface methodology. Cyclic voltammetry and electrochemical impedance spectroscopy measurements were employed to characterize the optimized immunosensor. The DHEAS detection principle was based on the variation of charge transfer resistance (∆Rct) relative to the Fe(CN)64-/3- electrochemical probe after immunoassays in the presence of the biomarker. A linear relationship between ∆Rct and DHEAS concentration was verified in the range from 10.0 to 110.0 µg dL-1, with a LOD of 7.4 µg dL-1. Besides the good sensitivity, the immunosensor displayed accuracy, stability, and specificity to detect DHEAS. The promising analytical performance of ox-GCE/AuNPs-ARG/IgM was confirmed by quantifying DHEAS in real patient plasma samples, with results that were comparable to the reference chemiluminescence assay. Our results suggest that the presented immunosensor can find clinical applications in the early diagnosis of pACC and to monitor DHEAS levels in other adrenal pathologies.
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Affiliation(s)
- Dhésmon Lima
- Department of Chemistry, Universidade Estadual de Ponta Grossa, Av. General Carlos Cavalcanti, 4748, 84030-900 Ponta Grossa, Paraná, Brazil
| | - Juliana Inaba
- Department of Chemistry, Universidade Estadual de Ponta Grossa, Av. General Carlos Cavalcanti, 4748, 84030-900 Ponta Grossa, Paraná, Brazil
| | - Luma Clarindo Lopes
- Department of Chemistry, Universidade Estadual de Ponta Grossa, Av. General Carlos Cavalcanti, 4748, 84030-900 Ponta Grossa, Paraná, Brazil
| | - Giselle Nathaly Calaça
- Department of Chemistry, Instituto Federal do Paraná, Rodovia PR 323, KM 310, 87507-014 Umuarama, Paraná, Brazil
| | - Patrícia Los Weinert
- Department of Chemistry, Universidade Estadual de Ponta Grossa, Av. General Carlos Cavalcanti, 4748, 84030-900 Ponta Grossa, Paraná, Brazil
| | - Rafaela Lenzi Fogaça
- Department of Basic Pathology, Universidade Federal do Paraná, Av. Coronel Francisco H. dos Santos, 100, 81530-000 Curitiba, Paraná, Brazil
| | - Juliana Ferreira de Moura
- Department of Basic Pathology, Universidade Federal do Paraná, Av. Coronel Francisco H. dos Santos, 100, 81530-000 Curitiba, Paraná, Brazil
| | - Larissa Magalhães Alvarenga
- Department of Basic Pathology, Universidade Federal do Paraná, Av. Coronel Francisco H. dos Santos, 100, 81530-000 Curitiba, Paraná, Brazil
| | - Bonald Cavalcante de Figueiredo
- Department of Community Health, Universidade Federal do Paraná, Rua Padre Camargo, 261, 80069-240 Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632, 80250-060 Curitiba, Paraná, Brazil
| | - Karen Wohnrath
- Department of Chemistry, Universidade Estadual de Ponta Grossa, Av. General Carlos Cavalcanti, 4748, 84030-900 Ponta Grossa, Paraná, Brazil
| | - Christiana Andrade Pessôa
- Department of Chemistry, Universidade Estadual de Ponta Grossa, Av. General Carlos Cavalcanti, 4748, 84030-900 Ponta Grossa, Paraná, Brazil.
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7
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Fragni M, Fiorentini C, Rossini E, Fisogni S, Vezzoli S, Bonini SA, Dalmiglio C, Grisanti S, Tiberio GAM, Claps M, Cosentini D, Salvi V, Bosisio D, Terzolo M, Missale C, Facchetti F, Memo M, Berruti A, Sigala S. In vitro antitumor activity of progesterone in human adrenocortical carcinoma. Endocrine 2019; 63:592-601. [PMID: 30367443 DOI: 10.1007/s12020-018-1795-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/15/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE The management of patients with adrenocortical carcinoma (ACC) is challenging. As mitotane and chemotherapy show limited efficacy, there is an urgent need to develop therapeutic approaches. The aim of this study was to investigate the antitumor activity of progesterone and explore the molecular mechanisms underlying its cytotoxic effects in the NCI-H295R cell line and primary cell cultures derived from ACC patients. METHODS Cell viability, cell cycle, and apoptosis were analyzed in untreated and progesterone-treated ACC cells. The ability of progesterone to affect the Wnt/β-catenin pathway in NCI-H295R cells was investigated by immunofluorescence. Progesterone and mitotane combination experiments were also performed to evaluate their interaction on NCI-H295R cell viability. RESULTS We demonstrated that progesterone exerted a concentration-dependent inhibition of ACC cell viability. Apoptosis was the main mechanism, as demonstrated by a significant increase of apoptosis and cleaved-Caspase-3 levels. Reduction of β-catenin nuclear translocation may contribute to the progesterone cytotoxic effect. The progesterone antineoplastic activity was synergically increased when mitotane was added to the cell culture medium. CONCLUSIONS Our results show that progesterone has antineoplastic activity in ACC cells. The synergistic cytotoxic activity of progesterone with mitotane provides the rationale for testing this combination in a clinical study.
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Affiliation(s)
- Martina Fragni
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Chiara Fiorentini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Elisa Rossini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Simona Fisogni
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sara Vezzoli
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Sara A Bonini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Cristina Dalmiglio
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Guido A M Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Melanie Claps
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Deborah Cosentini
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Valentina Salvi
- Section of Oncology and Experimental Immunology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Daniela Bosisio
- Section of Oncology and Experimental Immunology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences University of Turin, Internal Medicine 1, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Cristina Missale
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Memo
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy.
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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8
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Ronchi CL. Adrenocortical tumors: challenges and recent advances in diagnosis and treatment. MINERVA ENDOCRINOL 2018; 44:1-3. [PMID: 30221892 DOI: 10.23736/s0391-1977.18.02915-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Cristina L Ronchi
- Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK - .,Center for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK - .,Division of Endocrinology and Metabolism, University Hospital of Wuerzburg, Wuerzburg, Germany -
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9
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Anderson KL, Adam MA, Thomas SM, Youngwirth L, Stang MT, Scheri RP, Roman SA, Sosa JA. Impact of Micro- and Macroscopically Positive Surgical Margins on Survival after Resection of Adrenocortical Carcinoma. Ann Surg Oncol 2018; 25:1425-1431. [DOI: 10.1245/s10434-018-6398-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 11/18/2022]
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10
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Altieri B, Sbiera S, Della Casa S, Weigand I, Wild V, Steinhauer S, Fadda G, Kocot A, Bekteshi M, Mambretti EM, Rosenwald A, Pontecorvi A, Fassnacht M, Ronchi CL. Livin/BIRC7 expression as malignancy marker in adrenocortical tumors. Oncotarget 2018; 8:9323-9338. [PMID: 28030838 PMCID: PMC5354734 DOI: 10.18632/oncotarget.14067] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022] Open
Abstract
Livin/BIRC7 is a member of the inhibitors of apoptosis proteins family, which are involved in tumor development through the inhibition of caspases. Aim was to investigate the expression of livin and other members of its pathway in adrenocortical tumors and in the adrenocortical carcinoma (ACC) cell line NCI-H295R. The mRNA expression of livin, its isoforms α and β, XIAP, CASP3 and DIABLO was evaluated by qRT-PCR in 82 fresh-frozen adrenal tissues (34 ACC, 25 adenomas = ACA, 23 normal adrenal glands = NAG). Livin protein expression was assessed by immunohistochemistry in 270 paraffin-embedded tissues (192 ACC, 58 ACA, 20 NAG). Livin, CASP3 and cleaved caspase-3 were evaluated in NCI-H295R after induction of livin overexpression. Relative livin mRNA expression was significantly higher in ACC than in ACA and NAG (0.060 ± 0.116 vs 0.004 ± 0.014 and 0.002 ± 0.009, respectively, p < 0.01), being consistently higher in tumors than in adjacent NAG and isoform β more expressed than α. No significant differences in CASP3, XIAP and DIABLO levels were found among these groups. In immunohistochemistry, livin was localized in both cytoplasm and nuclei. The ratio between cytoplasmic and nuclear staining was significantly higher in ACC (1.51 ± 0.66) than in ACA (0.80 ± 0.35) and NAG (0.88 ± 0.27; p < 0.0001). No significant correlations were observed between livin expression and histopathological parameters or clinical outcome. In NCI-H295R cells, the livin overexpression slightly reduced the activation of CASP3, but did not correlate with cell viability. In conclusion, livin is specifically over-expressed in ACC, suggesting that it might be involved in adrenocortical tumorigenesis and represent a new molecular marker of malignancy.
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Affiliation(s)
- Barbara Altieri
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital of Wuerzburg, Germany.,Division of Endocrinology and Metabolic Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Silviu Sbiera
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Germany
| | - Silvia Della Casa
- Division of Endocrinology and Metabolic Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Isabel Weigand
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital of Wuerzburg, Germany
| | - Vanessa Wild
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Germany.,Department of Pathology, University of Wuerzburg, Germany
| | - Sonja Steinhauer
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital of Wuerzburg, Germany
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, Rome, Italy
| | - Arkadius Kocot
- Department of Urology, University Hospital of Wuerzburg, Germany
| | - Michaela Bekteshi
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital of Wuerzburg, Germany
| | - Egle M Mambretti
- Department of Anesthesiology and Critical Care, University Hospital of Wuerzburg, Germany
| | | | - Alfredo Pontecorvi
- Division of Endocrinology and Metabolic Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital of Wuerzburg, Germany.,Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Germany
| | - Cristina L Ronchi
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital of Wuerzburg, Germany
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11
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Payabyab EC, Balasubramaniam S, Edgerly M, Velarde M, Merino MJ, Venkatesan AM, Leuva H, Litman T, Bates SE, Fojo T. Adrenocortical Cancer: A Molecularly Complex Disease Where Surgery Matters. Clin Cancer Res 2018; 22:4989-5000. [PMID: 27742785 DOI: 10.1158/1078-0432.ccr-16-1570] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022]
Abstract
The development of new therapies has lagged behind for rare cancers without defined therapeutic targets. Adrenocortical cancer is no exception. Mitotane, an older agent considered "adrenolytic," is used both to control symptoms in advanced disease and as adjuvant therapy after surgical resection. Molecular characterization of adrenocortical cancer has deepened our understanding of this genetically complex disease while identifying subgroups whose importance remains to be determined. Unfortunately, such studies have yet to demonstrate a therapeutic target for drug development, and to date, no targeted therapy has achieved meaningful outcomes. Consequently, first-line therapy for metastatic disease remains a combination regimen of etoposide, doxorubicin, and cisplatinum established in a randomized clinical trial. In addition to evaluating recent studies in adrenocortical cancer, we raise one critical clinical issue-the risk of peritoneal dissemination following laparoscopic resection of adrenocortical cancer. In a retrospective case series of 267 patients referred to the NCI for the treatment of recurrent or advanced adrenocortical cancer, we found extensive peritoneal dissemination in 25 of the 45 patients (55.6%) who had undergone laparoscopic resection, compared with only 7 of the 222 patients (3%) who had undergone an open resection (P < 0.0001). Although this has been debated in the literature, our data argue for an end to laparoscopic resection of adrenocortical cancers to avoid peritoneal dissemination, a complication of laparoscopy that is uniformly fatal. Clin Cancer Res; 22(20); 4989-5000. ©2016 AACR SEE ALL ARTICLES IN THIS CCR FOCUS SECTION, "ENDOCRINE CANCERS REVISING PARADIGMS".
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Affiliation(s)
- Eden C Payabyab
- Surgery Branch and Thoracic & GI Oncology Branch, NCI, NIH, Bethesda, Maryland
| | - Sanjeeve Balasubramaniam
- Division of Oncology Products 1, OHOP, CDER, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Maureen Edgerly
- Medical Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Margarita Velarde
- Medical Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Maria J Merino
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Aradhana M Venkatesan
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harshraj Leuva
- James J. Peters Veterans Administration Medical Center, Bronx, New York
| | - Thomas Litman
- Medical Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Susan E Bates
- James J. Peters Veterans Administration Medical Center, Bronx, New York. Division of Medical Oncology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Tito Fojo
- James J. Peters Veterans Administration Medical Center, Bronx, New York. Division of Medical Oncology, Department of Medicine, Columbia University Medical Center, New York, New York.
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12
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Casaburi I, Avena P, De Luca A, Sirianni R, Rago V, Chimento A, Trotta F, Campana C, Rainey WE, Pezzi V. GPER-independent inhibition of adrenocortical cancer growth by G-1 involves ROS/Egr-1/BAX pathway. Oncotarget 2017; 8:115609-115619. [PMID: 29383185 PMCID: PMC5777797 DOI: 10.18632/oncotarget.23314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022] Open
Abstract
We previously demonstrated that treatment of the H295R adrenocortical cancer cell line with the non-steroidal, high-affinity GPER (G protein-coupled estrogen receptor 1) agonist G-1 reduced tumor growth in vitro and in vivo through a GPER independent action. Moreover, we observed that G-1 treatment induces cell-cycle arrest and apoptosis following a sustained ERK1/2 activation. However, the precise mechanisms causing these effects were not clarified. Starting from our preliminary published results, we performed a microarray study that clearly evidenced a strong and significative up-regulation of EGR-1 gene in H295R cells treated for 24h with micromolar concentration of G-1. The microarray findings were confirmed by RT-PCR and Western-blot analysis as well as by immunofluorescence that revealed a strong nuclear staining for EGR-1 after G-1 treatment. EGR-1 is a point of convergence of many intracellular signaling cascades that control tumor cell growth and proliferation as well as others that relate to cell death machinery. Here we found that the increased Egr-1 expression was a consequence of G-1-mediated ROS-dependent ERK activation that were promptly reversed by the presence of the antioxidant n-acetyl-cysteine. Finally, we observed that silencing EGR-1 gene expression reversed the main effects induced by G-1 in ACC cells, including upregulation of the negative regulator of cell cycle, p21Waf1/Cip1 and the positive regulator of mitochondrial apoptotic pathway, BAX, as well as the cell growth inhibition. The identified ROS/MAPK/Egr-1/BAX pathway as a potential off-target effect of the G-1 could be useful in implementing the pharmacological approach for ACC therapy.
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Affiliation(s)
- Ivan Casaburi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Paola Avena
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Arianna De Luca
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Rosa Sirianni
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Vittoria Rago
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Adele Chimento
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Francesca Trotta
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Carmela Campana
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - William E Rainey
- Departments of Molecular & Integrative Physiology and Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
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13
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Henning JEK, Deutschbein T, Altieri B, Steinhauer S, Kircher S, Sbiera S, Wild V, Schlötelburg W, Kroiss M, Perotti P, Rosenwald A, Berruti A, Fassnacht M, Ronchi CL. Gemcitabine-Based Chemotherapy in Adrenocortical Carcinoma: A Multicenter Study of Efficacy and Predictive Factors. J Clin Endocrinol Metab 2017; 102:4323-4332. [PMID: 29092062 DOI: 10.1210/jc.2017-01624] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/14/2017] [Indexed: 02/11/2023]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is rare and confers an unfavorable prognosis in advanced stages. Other than combination chemotherapy with cisplatin, etoposide, doxorubicin, and mitotane, the second- and third-line regimens are not well-established. Gemcitabine (GEM)-based chemotherapy was suggested in a phase 2 clinical trial with 28 patients. In other solid tumors, human equilibrative nucleoside transporter type 1 (hENT1) and/or ribonucleotide reductase catalytic subunit M1 (RRM1) expression have been associated with resistance to GEM. OBJECTIVE To assess the efficacy of GEM-based chemotherapy in ACC in a real-world setting and the predictive role of molecular parameters. DESIGN Retrospective multicenter study. SETTING Referral centers of university hospitals. PATIENTS AND MATERIALS A total of 145 patients with advanced ACC were treated with GEM-based chemotherapy (132 with concomitant capecitabine). Formalin-fixed paraffin-embedded tumor material was available for 70 patients for immunohistochemistry. OUTCOME MEASURES The main outcome measures were progression-free survival (PFS) and an objective response to GEM-based chemotherapy. The secondary objective was the predictive role of hENT1 and RRM1. RESULTS The median PFS for the patient population was 12 weeks (range, 1 to 94). A partial response or stable disease was achieved in 4.9% and 25.0% of cases, with a median duration of 26.8 weeks. Treatment was generally well tolerated, with adverse events of grade 3 or 4 occurring in 11.0% of cases. No substantial effect of hENT1 and/or RRM1 expression was observed in response to GEM-based chemotherapy. CONCLUSIONS GEM-based chemotherapy is a well-tolerated, but modestly active, regimen against advanced ACC. No reliable molecular predictive factors could be identified. Owing to the scarce alternative therapeutic options, GEM-based chemotherapy remains an important option for salvage treatment for advanced ACC.
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Affiliation(s)
- Judith E K Henning
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg 97070, Germany
- Division of Endocrinology and Metabolic Diseases, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Sonja Steinhauer
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Stefan Kircher
- Institute of Pathology, University of Wuerzburg, Wuerzburg 97070, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Silviu Sbiera
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Vanessa Wild
- Institute of Pathology, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Wiebke Schlötelburg
- Institute for Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Wuerzburg 97070, Germany
| | - Matthias Kroiss
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Paola Perotti
- Division of Internal Medicine I, University of Turin, San Luigi Hospital, Turin 10124, Italy
| | - Andreas Rosenwald
- Institute of Pathology, University of Wuerzburg, Wuerzburg 97070, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Alfredo Berruti
- Division of Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Spedali Civili Hospital, Brescia 25151, Italy
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg 97070, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg 97070, Germany
| | - Cristina L Ronchi
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg 97070, Germany
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14
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Sbiera S, Sbiera I, Ruggiero C, Doghman-Bouguerra M, Korpershoek E, de Krijger RR, Ettaieb H, Haak H, Volante M, Papotti M, Reimondo G, Terzolo M, Luconi M, Nesi G, Mannelli M, Libé R, Ragazzon B, Assié G, Bertherat J, Altieri B, Fadda G, Rogowski-Lehmann N, Reincke M, Beuschlein F, Fassnacht M, Lalli E. Assessment of VAV2 Expression Refines Prognostic Prediction in Adrenocortical Carcinoma. J Clin Endocrinol Metab 2017; 102:3491-3498. [PMID: 28911143 DOI: 10.1210/jc.2017-00984] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/28/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with overall poor prognosis. The Ki67 labeling index (LI) has a major prognostic role in localized ACC after complete resection, but its estimates may suffer from considerable intra- and interobserver variability. VAV2 overexpression induced by increased Steroidogenic Factor-1 dosage is an essential factor driving ACC tumor cell invasion. OBJECTIVE To assess the prognostic role of VAV2 expression in ACC by investigation of a large cohort of patients. DESIGN, SETTING, AND PARTICIPANTS A total of 171 ACC cases (157 primary tumors, six local recurrences, eight metastases) from seven European Network for the Study of Adrenal Tumors centers were studied. OUTCOME MEASUREMENTS H-scores were generated to quantify VAV2 expression. VAV2 expression was divided into two categories: low (H-score, <2) and high (H-score, ≥2). The Ki67 LI retrieved from patients' pathology records was also categorized into low (<20%) and high (≥20%). Clinical and immunohistochemical markers were correlated with progression-free survival (PFS) and overall survival (OS). RESULTS VAV2 expression and Ki67 LI were significantly correlated with each other and with PFS and OS. Heterogeneity of VAV2 expression inside the same tumor was very low. Combined assessment of VAV2 expression and Ki67 LI improved patient stratification to low-risk and high-risk groups. CONCLUSION Combined assessment of Ki67 LI and VAV2 expression improves prognostic prediction in ACC.
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Affiliation(s)
- Silviu Sbiera
- Department of Internal Medicine I - Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, 97080 Wurzburg, Germany
| | - Iuliu Sbiera
- Department of Internal Medicine I - Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, 97080 Wurzburg, Germany
| | - Carmen Ruggiero
- Université Côte d'Azur, Sophia Antipolis, 06560 Valbonne, France
- CNRS UMR7275, Sophia Antipolis, 06560 Valbonne, France
- NEOGENEX CNRS International Associated Laboratory, Sophia Antipolis, 06560 Valbonne, France
- Institut de Pharmacologie Moléculaire et Cellulaire, Sophia Antipolis, 06560 Valbonne, France
| | - Mabrouka Doghman-Bouguerra
- Université Côte d'Azur, Sophia Antipolis, 06560 Valbonne, France
- CNRS UMR7275, Sophia Antipolis, 06560 Valbonne, France
- NEOGENEX CNRS International Associated Laboratory, Sophia Antipolis, 06560 Valbonne, France
- Institut de Pharmacologie Moléculaire et Cellulaire, Sophia Antipolis, 06560 Valbonne, France
| | - Esther Korpershoek
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Ronald R de Krijger
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Pathology, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands
| | - Hester Ettaieb
- Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven/Veldhoven, The Netherlands
| | - Harm Haak
- Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven/Veldhoven, The Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, 6202 AZ Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, 6200 MD Maastricht, The Netherlands
| | - Marco Volante
- Department of Oncology, University of Turin at San Luigi Hospital, 10043 Orbassano, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin at San Luigi Hospital, 10043 Orbassano, Italy
| | - Giuseppe Reimondo
- Department of Clinical and Biological Sciences, University of Turin at San Luigi Hospital, 10043 Orbassano, Italy
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, University of Turin at San Luigi Hospital, 10043 Orbassano, Italy
| | - Michaela Luconi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, 50139 Florence, Italy
| | - Gabriella Nesi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, 50139 Florence, Italy
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, 50139 Florence, Italy
| | - Rossella Libé
- Inserm U1016, Institut Cochin, 75014 Paris, France
- CNRS UMR8104, 75014 Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, 75014 Paris, France
| | - Bruno Ragazzon
- Inserm U1016, Institut Cochin, 75014 Paris, France
- CNRS UMR8104, 75014 Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, 75014 Paris, France
| | - Guillaume Assié
- Inserm U1016, Institut Cochin, 75014 Paris, France
- CNRS UMR8104, 75014 Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, 75014 Paris, France
| | - Jérôme Bertherat
- Inserm U1016, Institut Cochin, 75014 Paris, France
- CNRS UMR8104, 75014 Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, 75014 Paris, France
| | - Barbara Altieri
- Department of Internal Medicine I - Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, 97080 Wurzburg, Germany
- Division of Endocrinology and Metabolic Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | | | - Martin Reincke
- Medizinische Klinik and Poliklinik IV, Ludwig-Maximilians-Universität, 80336 Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik and Poliklinik IV, Ludwig-Maximilians-Universität, 80336 Munich, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, 8091 Zurich, Switzerland
| | - Martin Fassnacht
- Comprehensive Cancer Center Mainfranken, University of Würzburg, 97080 Wurzburg, Germany
| | - Enzo Lalli
- Université Côte d'Azur, Sophia Antipolis, 06560 Valbonne, France
- CNRS UMR7275, Sophia Antipolis, 06560 Valbonne, France
- NEOGENEX CNRS International Associated Laboratory, Sophia Antipolis, 06560 Valbonne, France
- Institut de Pharmacologie Moléculaire et Cellulaire, Sophia Antipolis, 06560 Valbonne, France
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15
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Ruggiero C, Doghman-Bouguerra M, Sbiera S, Sbiera I, Parsons M, Ragazzon B, Morin A, Robidel E, Favier J, Bertherat J, Fassnacht M, Lalli E. Dosage-dependent regulation of VAV2 expression by steroidogenic factor-1 drives adrenocortical carcinoma cell invasion. Sci Signal 2017; 10:10/469/eaal2464. [PMID: 28270555 DOI: 10.1126/scisignal.aal2464] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a dismal prognosis. Genomic studies have enabled progress in our understanding of the molecular bases of ACC, but factors that influence its prognosis are lacking. Amplification of the gene encoding the transcription factor steroidogenic factor-1 (SF-1; also known as NR5A1) is one of the genetic alterations common in ACC. We identified a transcriptional regulatory mechanism involving increased abundance of VAV2, a guanine nucleotide exchange factor for small GTPases that control the cytoskeleton, driven by increased expression of the gene encoding SF-1 in ACC. Manipulating SF-1 and VAV2 abundance in cultured ACC cells revealed that VAV2 was a critical factor for SF-1-induced cytoskeletal remodeling and invasion in culture (Matrigel) and in vivo (chicken chorioallantoic membrane) models. Analysis of ACC patient cohorts indicated that greater VAV2 abundance robustly correlated with poor prognosis in ACC patients. Because VAV2 is a druggable target, our findings suggest that blocking VAV2 may be a new therapeutic approach to inhibit metastatic progression in ACC patients.
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Affiliation(s)
- Carmen Ruggiero
- Université Côte d'Azur, Sophia Antipolis, 06560 Valbonne, France.,CNRS UMR7275, Sophia Antipolis, 06560 Valbonne, France.,NEOGENEX CNRS International Associated Laboratory, Sophia Antipolis, 06560 Valbonne, France.,Institut de Pharmacologie Moléculaire et Cellulaire, Sophia Antipolis, 06560 Valbonne, France
| | - Mabrouka Doghman-Bouguerra
- Université Côte d'Azur, Sophia Antipolis, 06560 Valbonne, France.,CNRS UMR7275, Sophia Antipolis, 06560 Valbonne, France.,NEOGENEX CNRS International Associated Laboratory, Sophia Antipolis, 06560 Valbonne, France.,Institut de Pharmacologie Moléculaire et Cellulaire, Sophia Antipolis, 06560 Valbonne, France
| | - Silviu Sbiera
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany
| | - Iuliu Sbiera
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany
| | - Maddy Parsons
- Randall Division of Cell and Molecular Biophysics, King's College London, London SE1 1UL, U.K
| | - Bruno Ragazzon
- Inserm, U1016, Institut Cochin, 75014 Paris, France.,CNRS UMR8104, 75014 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, 74014 Paris, France
| | - Aurélie Morin
- Université Paris Descartes, Sorbonne Paris Cité, 74014 Paris, France.,Inserm, UMR970, Paris Cardiovascular Research Centre, 75015 Paris, France
| | - Estelle Robidel
- Université Paris Descartes, Sorbonne Paris Cité, 74014 Paris, France.,Inserm, UMR970, Paris Cardiovascular Research Centre, 75015 Paris, France
| | - Judith Favier
- Université Paris Descartes, Sorbonne Paris Cité, 74014 Paris, France.,Inserm, UMR970, Paris Cardiovascular Research Centre, 75015 Paris, France
| | - Jérôme Bertherat
- Inserm, U1016, Institut Cochin, 75014 Paris, France.,CNRS UMR8104, 75014 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, 74014 Paris, France
| | - Martin Fassnacht
- Comprehensive Cancer Center Mainfranken, University of Würzburg, 97080 Würzburg, Germany
| | - Enzo Lalli
- Université Côte d'Azur, Sophia Antipolis, 06560 Valbonne, France. .,CNRS UMR7275, Sophia Antipolis, 06560 Valbonne, France.,NEOGENEX CNRS International Associated Laboratory, Sophia Antipolis, 06560 Valbonne, France.,Institut de Pharmacologie Moléculaire et Cellulaire, Sophia Antipolis, 06560 Valbonne, France
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16
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17
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Choi YM, Kwon H, Jeon MJ, Sung TY, Hong SJ, Kim TY, Kim WB, Shong YK, Lee JL, Song DE, Kim WG. Clinicopathological Features Associated With the Prognosis of Patients With Adrenal Cortical Carcinoma: Usefulness of the Ki-67 Index. Medicine (Baltimore) 2016; 95:e3736. [PMID: 27227935 PMCID: PMC4902359 DOI: 10.1097/md.0000000000003736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare tumor with a poor prognosis. Identification of clinicopathological features and molecular prognostic markers is important for the treatment of ACC. The aim of this study was to evaluate the clinical and histopathological features of ACC for prognostic prediction.This retrospective cohort study included 86 patients pathologically confirmed with ACC in a single center. Ki-67 index was evaluated by immunohistochemical staining of paraffin-embedded samples.The median age of the 86 (46 male and 40 female) patients with ACC was 49 years old (range 21-78), and the mean primary tumor size was 12.2 ± 5.2 cm. ACCs were incidentally found in 29 patients (34%). Three patients (3%) had bilateral ACC, and 59 patients (69%) had distant metastasis (37 synchronous and 22 metachronous). Twenty-four patients (28%) had symptoms from hormone excess or mass effects, and 25 patients (29%) had nonspecific symptoms. The 5-year survival rate for ACC was 28%. Sixty patients underwent surgical treatment, including 37 patients with an R0 resection. Tumor size, Ki-67 index, stage, and resection status were independently associated with overall survival by multivariate analysis. In patients with R0 resection, recurrence was significantly associated with larger tumor size and functional tumor.Tumor size, Ki-67 index, stage, and resection status are important prognostic indicators of survival in ACC patients.
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Affiliation(s)
- Yun Mi Choi
- From the Departments of Internal Medicine (YMC, HK, MJJ, TYK, WBK, YKS, JLL, WGK), Surgery (T-YS, SJH), and Pathology (DES), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Liu J, Xu M, Zhao Y, Ao C, Wu Y, Chen Z, Wang B, Bai X, Li M, Hu W. n-3 polyunsaturated fatty acids abrogate mTORC1/2 signaling and inhibit adrenocortical carcinoma growth in vitro and in vivo. Oncol Rep 2016; 35:3514-22. [PMID: 27035283 DOI: 10.3892/or.2016.4720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/06/2016] [Indexed: 11/06/2022] Open
Abstract
n-3 polyunsaturated fatty acids (PUFAs) are essential for human health and have been reported to reduce the risk of cancer, inhibit the growth of various types of tumors both in vitro and in vivo, and affect adrenal function. However, their effects on adrenocortical carcinoma (ACC) are not known. In the present study, we demonstrated that docosahexenoic acid (DHA) inhibited ACC cell proliferation, colony formation and cell cycle progression, and promoted apoptosis. In addition, ectopic expression of fat-1, a desaturase that converts n-6 to n-3 PUFAs endogenously, also inhibited ACC cell proliferation. Moreover, supplementing n-3 PUFAs in the diet efficiently prevented ACC cell growth in xenograft models. Notably, implanted ACC cells were unable to grow in fat-1 transgenic severe combined immune deficiency mice. Further study revealed that exogenous and endogenous n-3 PUFAs efficiently suppressed both mTOR complex 1 (mTORC1) and mTORC2 signaling in ACC in vitro and in vivo. Taken together, our findings provide comprehensive preclinical evidence that n-3 PUFAs efficiently prevent ACC growth by inhibiting mTORC1/2, which may have important implications in the treatment of ACC.
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Affiliation(s)
- Jun Liu
- Department of Urology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, P.R. China
| | - Meinian Xu
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, P.R. China
| | - Yongbin Zhao
- Department of Urology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, P.R. China
| | - Chunping Ao
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, P.R. China
| | - Yukun Wu
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, P.R. China
| | - Zhenguo Chen
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, P.R. China
| | - Bangqi Wang
- Department of Urology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, P.R. China
| | - Xiaochun Bai
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, P.R. China
| | - Ming Li
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, P.R. China
| | - Weilie Hu
- Department of Urology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, P.R. China
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19
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El Ghorayeb N, Rondeau G, Latour M, Cohade C, Olney H, Lacroix A, Perrotte P, Sabourin A, Mazzuco TL, Bourdeau I. Rapid and Complete Remission of Metastatic Adrenocortical Carcinoma Persisting 10 Years After Treatment With Mitotane Monotherapy: Case Report and Review of the Literature. Medicine (Baltimore) 2016; 95:e3180. [PMID: 27043680 PMCID: PMC4998541 DOI: 10.1097/md.0000000000003180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mitotane has been used for more than 5 decades as therapy for adrenocortical carcinoma (ACC). However its mechanism of action and the extent of tumor response remain incompletely understood. To date no cases of rapid and complete remission of metastatic ACC with mitotane monotherapy has been reported. A 52-year-old French Canadian man presented with metastatic disease 2 years following a right adrenalectomy for stage III nonsecreting ACC. He was started on mitotane which was well tolerated despite rapid escalation of the dose. The patient course was exceptional as he responded to mitotane monotherapy after only few months of treatment. Initiation of chemotherapy was not needed and he remained disease-free with good quality of life on low maintenance dose of mitotane during the following 10 years. A germline heterozygous TP53 exon 4 polymorphism c.215C>G (p. Pro72Arg) was found. Immunohistochemical stainings for IGF-2 and cytoplasmic β-catenin were positive. Advanced ACC is an aggressive disease with poor prognosis and the current therapeutic options remain limited. These findings suggest that mitotane is a good option for the treatment of metastatic ACC and might result in rapid complete remission in selected patients.
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Affiliation(s)
- Nada El Ghorayeb
- From the Division of Endocrinology (NEG, GR, AL, IB), Department of Medicine; Department of Pathology (ML); Division of Nuclear Medicine (CC), Department of Radiology; Division of Oncology (HO), Department of Medicine; Division of Urology (PP), Department of Surgery; Division of Endocrinology (AS), Department of Medecine, Hôpital Honoré Mercier, Saint-Hyacinthe, Québec, Canada; and Division of Endocrinology (TLM), Medical Clinical Department, Health Sciences Centre, Universidade Estadual de Londrina (UEL), Paraná, Brazil
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20
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Glover AR, Hassan N, Joo LJS, Kwok G, Zhao JT, Sidhu SB. Could miRNA replacement be a novel therapy for adrenocortical carcinoma? INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije.15.28] [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
Adrenocortical carcinoma (ACC) has poor outcomes and there is a need for novel effective treatments for metastatic disease and adjuvant therapy. miRNAs are small endogenous noncoding RNAs that control gene expression. miRNAs are dysregulated in all cancers and manipulation of miRNA levels is under investigation as a novel therapy in other cancers with poor outcomes such as mesothelioma. In this review, the rationale for miRNA therapy will be presented along with the current understanding of the role of miRNA dysregulation and miRNA regulation of ACC. Potential therapeutic approaches of miRNA therapy using established delivery systems such as liposomes and targeted nanocells will be presented, along with the future challenges of establishing miRNA therapy in clinical trials for ACC.
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Affiliation(s)
- Anthony R Glover
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, NSW, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Vital Translational Research Unit, Northern Sydney Local Health District, Cancer Institute NSW, Australia
| | - Nunki Hassan
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, NSW, Australia
| | - Lauren Jin Suk Joo
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, NSW, Australia
| | - Grace Kwok
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, NSW, Australia
| | - Jing Ting Zhao
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, NSW, Australia
- Sydney Vital Translational Research Unit, Northern Sydney Local Health District, Cancer Institute NSW, Australia
| | - Stan B Sidhu
- Cancer Genetics Laboratory, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- Sydney Medical School Northern, Royal North Shore Hospital, University of Sydney, NSW, Australia
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Vital Translational Research Unit, Northern Sydney Local Health District, Cancer Institute NSW, Australia
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21
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Casaburi I, Avena P, De Luca A, Chimento A, Sirianni R, Malivindi R, Rago V, Fiorillo M, Domanico F, Campana C, Cappello AR, Sotgia F, Lisanti MP, Pezzi V. Estrogen related receptor α (ERRα) a promising target for the therapy of adrenocortical carcinoma (ACC). Oncotarget 2015; 6:25135-48. [PMID: 26312764 PMCID: PMC4694820 DOI: 10.18632/oncotarget.4722] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/17/2015] [Indexed: 12/12/2022] Open
Abstract
The pathogenesis of the adrenocortical cancer (ACC) involves integration of molecular signals and the interplay of different downstream pathways (i.e. IGFII/IGF1R, β-catenin, Wnt, ESR1). This tumor is characterized by limited therapeutic options and unsuccessful treatments. A useful strategy to develop an effective therapy for ACC is to identify a common downstream target of these multiple pathways. A good candidate could be the transcription factor estrogen-related receptor alpha (ERRα) because of its ability to regulate energy metabolism, mitochondrial biogenesis and signalings related to cancer progression. In this study we tested the effect of ERRα inverse agonist, XCT790, on the proliferation of H295R adrenocortical cancer cell line. Results from in vitro and in vivo experiments showed that XCT790 reduced H295R cell growth. The inhibitory effect was associated with impaired cell cycle progression which was not followed by any apoptotic event. Instead, incomplete autophagy and cell death by a necrotic processes, as a consequence of the cell energy failure, induced by pharmacological reduction of ERRα was evidenced. Our results indicate that therapeutic strategies targeting key factors such as ERRα that control the activity and signaling of bioenergetics processes in high-energy demanding tumors could represent an innovative/alternative therapy for the treatment of ACC.
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Affiliation(s)
- Ivan Casaburi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Paola Avena
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Arianna De Luca
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Adele Chimento
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Rosa Sirianni
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Rocco Malivindi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Vittoria Rago
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Marco Fiorillo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Francesco Domanico
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Carmela Campana
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Anna Rita Cappello
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Federica Sotgia
- The Breakthrough Breast Cancer Research Unit and the Manchester Centre for Cellular Metabolism, Institute of Cancer Sciences, University of Manchester, UK
| | - Michael P. Lisanti
- The Breakthrough Breast Cancer Research Unit and the Manchester Centre for Cellular Metabolism, Institute of Cancer Sciences, University of Manchester, UK
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
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22
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Spontaneously metachronous ruptures of adrenocortical carcinoma and its contralateral adrenal metastasis. Int Cancer Conf J 2015; 5:90-97. [PMID: 31149433 DOI: 10.1007/s13691-015-0235-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/17/2015] [Indexed: 12/16/2022] Open
Abstract
Adrenocortical carcinomas (ACCs) are rare neoplasms. In spite of its rarity, ACCs are the second most lethal endocrine cancer after anaplastic thyroid carcinomas. Currently, the only chance for a cure is an early diagnosis and a radical surgical resection. We present the case of a previously unreported bilateral adrenal hemorrhage occurring in a 59-year-old Caucasian male who was admitted to our surgical division with the diagnosis of a right retroperitoneal spontaneous hemorrhage. Imaging revealed a 10-cm ruptured right adrenal mass with no other abdominal lesions, endocrine screening results were normal, and a right adrenalectomy was performed. Pathology revealed a ruptured ACC. The postoperative period was uneventful and the patient was discharged. While recovering, 3 weeks after the operation, the patient showed the same symptoms on the contralateral side. Imaging once again revealed a retroperitoneal hemorrhage due to a 5-cm ruptured left adrenal mass. Endocrine screening showed a frank peripheral hypercortisolism and imaging showed a huge metastatic dissemination to the liver, lungs, and retroperitoneal space. An urgent left adrenalectomy was performed and pathology showed a metastatic ruptured ACC. The patient was placed in substitutive therapy but never recovered and died of penta lobar pneumonia on postoperative day 31. An extensive review of the current literature on the issue was performed. ACC is confirmed to be a lethal cancer. Rupture is the rarest clinical presentation and appears to be caused by the tumor's growth rate more than the tumor dimensions itself. The use of endocrine screening on such hemodynamically unstable patients is questionable.
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23
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Uruc F, Urkmez A, Yuksel OH, Sahin A, Verit A. Androgen secreting giant adrenocortical carcinoma with no metastases: A case report and review of the literature. Can Urol Assoc J 2015; 9:E644-7. [PMID: 26425231 DOI: 10.5489/cuaj.2867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Functional adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Over half (60%) of ACCs bigger than 6 cm synthesize hormones; hormone-secreting ACCs generally include virilization, feminization or Cushing syndrome. Besides, 82% of ACCs are metastatic at the time of diagnosis. While a 48-year-old female patient was examined for abdominal pain and flushing, we detected a non-metastasizing mass (23 × 18 × 16 cm) in the adrenal lodge. The mass was extracted en bloc during open exploration and its histopathology was reported as ACC. We review the literature and report the largest androgen-producing, clinically silent ACC mass cited in the literature so far.
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Affiliation(s)
- Fatih Uruc
- Fatih Sultan Mehmet Research and Training Hospital, Department of Urology, Içerenkoy/Atasehir, Istanbul, Turkey
| | - Ahmet Urkmez
- Fatih Sultan Mehmet Research and Training Hospital, Department of Urology, Içerenkoy/Atasehir, Istanbul, Turkey
| | - Ozgur Haki Yuksel
- Fatih Sultan Mehmet Research and Training Hospital, Department of Urology, Içerenkoy/Atasehir, Istanbul, Turkey
| | - Aytac Sahin
- Fatih Sultan Mehmet Research and Training Hospital, Department of Urology, Içerenkoy/Atasehir, Istanbul, Turkey
| | - Ayhan Verit
- Fatih Sultan Mehmet Research and Training Hospital, Department of Urology, Içerenkoy/Atasehir, Istanbul, Turkey
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24
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Margonis GA, Kim Y, Prescott JD, Tran TB, Postlewait LM, Maithel SK, Wang TS, Evans DB, Hatzaras I, Shenoy R, Phay JE, Keplinger K, Fields RC, Jin LX, Weber SM, Salem A, Sicklick JK, Gad S, Yopp AC, Mansour JC, Duh QY, Seiser N, Solorzano CC, Kiernan CM, Votanopoulos KI, Levine EA, Poultsides GA, Pawlik TM. Adrenocortical Carcinoma: Impact of Surgical Margin Status on Long-Term Outcomes. Ann Surg Oncol 2015; 23:134-41. [PMID: 26286195 DOI: 10.1245/s10434-015-4803-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The influence of surgical margin status on long-term outcomes of patients undergoing adrenal resection for ACC remains not well defined. We studied the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ACC. METHODS A total of 165 patients who underwent adrenal resection for ACC and met inclusion criteria were identified form a multi-institutional database. Clinicopathological data, pathologic margin status, and long-term outcomes were assessed. Patients were stratified into two groups based on margin status: R0 (margin >1 mm) versus R1. RESULTS R0 resection was achieved in 126 patients (76.4 %), whereas 39 patients (23.6 %) had an R1 resection. Median and 5-year OS for patients undergoing R0 resection were 96.3 months and 64.8 % versus 25.1 months and 33.8 % for patients undergoing an R1 resection (both p < 0.001). On multivariable analysis, surgical margin status was an independent predictor of worse OS (hazard ratio [HR] 2.22, 95 % confidence interval [CI] 1.03-4.77; p = 0.04). The incidence of recurrence also differed between the two groups; 5-year RFS was 30.3 % among patients with an R0 resection versus 13.8 % among patients who had an R1 resection (p = 0.03). Lymph node metastasis (N1) was an independent predictor of RFS (HR 2.70, 95 % CI 1.04-6.99; p = 0.04). CONCLUSIONS A positive margin after ACC resection was associated with worse long-term survival. Patient selection and an emphasis on surgical technique to achieve R0 margins are pivotal to optimizing the best chance for long-term outcome among patients with ACC.
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Affiliation(s)
| | - Yuhree Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason D Prescott
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thuy B Tran
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ioannis Hatzaras
- Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Rivfka Shenoy
- Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - John E Phay
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Kara Keplinger
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Linda X Jin
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sharon M Weber
- Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ahmed Salem
- Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jason K Sicklick
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Shady Gad
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Adam C Yopp
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John C Mansour
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Quan-Yang Duh
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Natalie Seiser
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Edward A Levine
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - George A Poultsides
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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25
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Kanjanapan Y, Prasanna T, Perampalam S, Yip D. The challenge of managing adrenocortical carcinoma: two case studies. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adrenocortical carcinoma is a rare entity affecting 1–2 people per million. It has a relatively poor prognosis, with an overall 5-year survival of 20–45%. The reasons include a high risk of recurrence following resection and relatively poor response to cytotoxic treatment. The use of the adrenalytic mitotane as adjuvant therapy is supported by level III evidence from cohort studies. In the metastatic setting, one randomized controlled trial provides level II evidence for a three-drug chemotherapy combination of cisplatin, etoposide and doxorubicin, with mitotane (EDP–M). We present two cases of adrenocortical carcinoma and discuss their management in light of the literature supporting the treatments. These cases illustrate the practicalities of management requiring a multidisciplinary team with the oncologist, endocrinologist, surgeon, anesthetist, radiologist and pathologist, all working in collaboration.
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Affiliation(s)
- Yada Kanjanapan
- Department of Medical Oncology, The Canberra Hospital, Garran ACT, Australia
- Australian National University Medical School, Acton, ACT, Australia
| | - Thiru Prasanna
- Department of Medical Oncology, The Canberra Hospital, Garran ACT, Australia
| | - Sumathy Perampalam
- Australian National University Medical School, Acton, ACT, Australia
- Endocrinology Department, The Canberra Hospital, Garran ACT, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran ACT, Australia
- Australian National University Medical School, Acton, ACT, Australia
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26
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Corcuff JB, Young J, Masquefa-Giraud P, Chanson P, Baudin E, Tabarin A. Rapid control of severe neoplastic hypercortisolism with metyrapone and ketoconazole. Eur J Endocrinol 2015; 172:473-81. [PMID: 25624013 DOI: 10.1530/eje-14-0913] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
CONTEXT Severe Cushing's syndrome elicited by ectopic ACTH syndrome (EAS) or adrenal carcinoma (ACC) can threaten life in the short term. The effectiveness of oral administration of the inhibitors of steroidogenesis ketoconazole and metyrapone in this situation is poorly described. OBJECTIVE To report the short-term effectiveness and tolerability of metyrapone and ketoconazole elicited either by EAS or by ACC in patients exhibiting severe hypercortisolism. DESIGN Retrospective analysis of data obtained for patients with urinary free cortisol (UFC) level estimated to be fivefold the upper limit of the normal range (ULN). PATIENTS AND SETTINGS A total of 14 patients with EAS and eight with ACC treated in two tertiary-care university hospitals. INTERVENTION Metyrapone and ketoconazole treatment in combination (along with symptomatic treatments for co-morbidities). MAIN OUTCOME Evolution of clinically relevant endpoints (blood pressure, kalaemia and glycaemia) and biological intensity of hypercortisolism 1 week and 1 month after starting steroidogenesis inhibition. RESULTS After 1 week of treatment, median UFC fell from 40.0 to 3.2 ULN and from 16.0 to 1.0 ULN in patients with EAS and ACC respectively. Median UFC after 1 month of treatment was 0.5 and 1.0 ULN in patients with EAS and ACC respectively and UFC values were normal in 73 and 86% of patients respectively. Clinical status improved dramatically along with kalaemia, glycaemia and blood pressure, allowing a decrease in the relevant treatments.Side effects were minimal and only two patients (one EAS and one ACC) experienced plasma transaminase elevations necessitating ketoconazole withdrawal. CONCLUSION Metyrapone-ketoconazole combination therapy is well tolerated and provides rapid control of endocrine cancer-related life-threatening hypercortisolism.
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Affiliation(s)
- Jean-Benoît Corcuff
- Department of Nuclear MedicineHaut Lévêque Hospital, F-33604 Pessac, FranceDepartment of EndocrinologyBicêtre Hospital, F-94275 Le Kremlin-Bicêtre, FranceDepartment of EndocrinologyHaut Lévêque Hospital, CHU Bordeaux, F-33604 Pessac, France andDepartment of Nuclear Medicine and OncologyGustave Roussy, F-94800 Villejuif, France
| | - Jacques Young
- Department of Nuclear MedicineHaut Lévêque Hospital, F-33604 Pessac, FranceDepartment of EndocrinologyBicêtre Hospital, F-94275 Le Kremlin-Bicêtre, FranceDepartment of EndocrinologyHaut Lévêque Hospital, CHU Bordeaux, F-33604 Pessac, France andDepartment of Nuclear Medicine and OncologyGustave Roussy, F-94800 Villejuif, France
| | - Pauline Masquefa-Giraud
- Department of Nuclear MedicineHaut Lévêque Hospital, F-33604 Pessac, FranceDepartment of EndocrinologyBicêtre Hospital, F-94275 Le Kremlin-Bicêtre, FranceDepartment of EndocrinologyHaut Lévêque Hospital, CHU Bordeaux, F-33604 Pessac, France andDepartment of Nuclear Medicine and OncologyGustave Roussy, F-94800 Villejuif, France
| | - Philippe Chanson
- Department of Nuclear MedicineHaut Lévêque Hospital, F-33604 Pessac, FranceDepartment of EndocrinologyBicêtre Hospital, F-94275 Le Kremlin-Bicêtre, FranceDepartment of EndocrinologyHaut Lévêque Hospital, CHU Bordeaux, F-33604 Pessac, France andDepartment of Nuclear Medicine and OncologyGustave Roussy, F-94800 Villejuif, France
| | - Eric Baudin
- Department of Nuclear MedicineHaut Lévêque Hospital, F-33604 Pessac, FranceDepartment of EndocrinologyBicêtre Hospital, F-94275 Le Kremlin-Bicêtre, FranceDepartment of EndocrinologyHaut Lévêque Hospital, CHU Bordeaux, F-33604 Pessac, France andDepartment of Nuclear Medicine and OncologyGustave Roussy, F-94800 Villejuif, France
| | - Antoine Tabarin
- Department of Nuclear MedicineHaut Lévêque Hospital, F-33604 Pessac, FranceDepartment of EndocrinologyBicêtre Hospital, F-94275 Le Kremlin-Bicêtre, FranceDepartment of EndocrinologyHaut Lévêque Hospital, CHU Bordeaux, F-33604 Pessac, France andDepartment of Nuclear Medicine and OncologyGustave Roussy, F-94800 Villejuif, France
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27
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Glover AR, Zhao JT, Ip JC, Lee JC, Robinson BG, Gill AJ, Soon PSH, Sidhu SB. Long noncoding RNA profiles of adrenocortical cancer can be used to predict recurrence. Endocr Relat Cancer 2015; 22:99-109. [PMID: 25595289 DOI: 10.1530/erc-14-0457] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adrenocortical carcinoma (ACC) is an aggressive malignancy with high rates of recurrence following surgical resection. Long noncoding RNAs (lncRNAs) play an important role in cancer development. Pathogenesis of adrenal tumours have been characterised by mRNA, microRNA and methylation expression signatures, but it is unknown if this extends to lncRNAs. This study describes lncRNA expression signatures in ACC, adrenal cortical adenoma (ACA) and normal adrenal cortex (NAC) and presents lncRNAs associated with ACC recurrence to identify novel prognostic and therapeutic targets. RNA was extracted from freshly frozen tissue with confirmation of diagnosis by histopathology. Focused lncRNA and mRNA transcriptome analysis was performed using the ArrayStar Human LncRNA V3.0 microarray. Differentially expressed lncRNAs were validated using quantitative reverse transcriptase-PCR and correlated with clinical outcomes. Microarray of 21 samples (ten ACCs, five ACAs and six NACs) showed distinct patterns of lncRNA expression between each group. A total of 956 lncRNAs were differentially expressed between ACC and NAC, including known carcinogenesis-related lncRNAs such as H19, GAS5, MALAT1 and PRINS (P≤0.05); 85 lncRNAs were differentially expressed between ACC and ACA (P≤0.05). Hierarchical clustering and heat mapping showed ACC samples correctly grouped compared with NAC and ACA. Sixty-six differentially expressed lncRNAs were found to be associated with ACC recurrence (P≤0.05), one of which, PRINS, was validated in a group of 20 ACCs and also found to be associated with metastatic disease on presentation. The pathogenesis of adrenal tumours extends to lncRNA dysregulation and low expression of the lncRNA PRINS is associated with ACC recurrence.
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Affiliation(s)
- A R Glover
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - J T Zhao
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - J C Ip
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - J C Lee
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - B G Robinson
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - A J Gill
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - P S H Soon
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - S B Sidhu
- Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia Cancer Genetics LaboratoryKolling Institute of Medical ResearchDepartments of EndocrinologyAnatomical PathologyRoyal North Shore Hospital and University of Sydney, St Leonards, New South Wales 2065, AustraliaDepartment of SurgeryBankstown Hospital and University of New South Wales, Bankstown, New South Wales 2065, AustraliaIngham Institute for Applied Medical ResearchLiverpool, New South Wales 2200, AustraliaUniversity of Sydney Endocrine Surgical UnitRoyal North Shore Hospital, St Leonards, New South Wales 2065, Australia
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28
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Ronchi CL, Sbiera S, Volante M, Steinhauer S, Scott-Wild V, Altieri B, Kroiss M, Bala M, Papotti M, Deutschbein T, Terzolo M, Fassnacht M, Allolio B. CYP2W1 is highly expressed in adrenal glands and is positively associated with the response to mitotane in adrenocortical carcinoma. PLoS One 2014; 9:e105855. [PMID: 25144458 PMCID: PMC4140842 DOI: 10.1371/journal.pone.0105855] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/26/2014] [Indexed: 12/24/2022] Open
Abstract
Background Adrenocortical tumors comprise frequent adenomas (ACA) and rare carcinomas (ACC). Human cytochrome P450 2W1 (CYP2W1) is highly expressed in some cancers holding the potential to activate certain drugs into tumor cytotoxins. Objective To investigate the CYP2W1 expression in adrenal samples and its relationship with clinical outcome in ACC. Material and Methods CYP2W1 expression was investigated by qRT-PCR in 13 normal adrenal glands, 32 ACA, 25 ACC, and 9 different non-adrenal normal tissue samples and by immunohistochemistry in 352 specimens (23 normal adrenal glands, 33 ACA, 239 ACC, 67 non-adrenal normal or neoplastic samples). Results CYP2W1 mRNA expression was absent/low in normal non-adrenal tissues, but high in normal and neoplastic adrenal glands (all P<0.01 vs non-adrenal normal tissues). Accordingly, CYP2W1 immunoreactivity was absent/low (H-score 0–1) in 72% of non-adrenal normal tissues, but high (H-score 2–3) in 44% of non-adrenal cancers, in 65% of normal adrenal glands, in 62% of ACAs and in 50% of ACCs (all P<0.001 vs non-adrenal normal tissues), being significantly increased in steroid-secreting compared to non-secreting tumors. In ACC patients treated with mitotane only, high CYP2W1 immunoreactivity adjusted for ENSAT stage was associated with longer overall survival and time to progression (P<0.05 and P<0.01, respectively), and with a better response to therapy both as palliative (response/stable disease in 42% vs 6%, P<0.01) or adjuvant option (absence of disease recurrence in 69% vs 45%, P<0.01). Conclusion CYP2W1 is highly expressed in both normal and neoplastic adrenal glands making it a promising tool for targeted therapy in ACC. Furthermore, CYP2W1 may represent a new predictive marker for the response to mitotane treatment.
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Affiliation(s)
- Cristina L. Ronchi
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- * E-mail:
| | - Silviu Sbiera
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Marco Volante
- Department of Oncology, University of Turin, San Luigi Hospital, Turin, Italy
| | - Sonja Steinhauer
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | | | - Barbara Altieri
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Matthias Kroiss
- Comprehensive Cancer Center Mainfranken, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Margarita Bala
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Mauro Papotti
- Department of Oncology, University of Turin, San Luigi Hospital, Turin, Italy
| | - Timo Deutschbein
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Massimo Terzolo
- Division of Internal Medicine I, University of Turin, San Luigi Hospital, Turin, Italy
| | - Martin Fassnacht
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Bruno Allolio
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
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