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. 2022 Apr 19;107(5):1239-1246.
doi: 10.1210/clinem/dgac046.

Temporal Trends in Outcomes in Patients With Adrenocortical Carcinoma: A Multidisciplinary Referral-center Experience

Marilyne Daher  1 , Jeena Varghese  1 , Stephen K Gruschkus  2 , Camilo Jimenez  1 , Steven G Waguespack  1 , Sara Bedrose  1   3 , Lina Altameemi  1 , Hadil Bazerbashi  4 , Aung Naing  5 , Vivek Subaiah  5 , Matthew T Campbell  6 , Amishi Y Shah  6 , Miao Zhang  7 , Rahul A Sheth  8 , Jose A Karam  9   10 , Christopher G Wood  9 , Nancy D Perrier  11 , Paul H Graham  11 , Jeffery E Lee  11 , Mouhammed Amir Habra  1
Affiliations

Temporal Trends in Outcomes in Patients With Adrenocortical Carcinoma: A Multidisciplinary Referral-center Experience

Marilyne Daher et al. J Clin Endocrinol Metab. .

Erratum in

Abstract

Context: Reporting temporal trends in adrenocortical carcinoma (ACC) helps guide management strategies.

Objective: This work aimed to report the trends in disease burden and clinical outcomes over time that cannot be adequately captured from individual clinical trials.

Methods: A retrospective study was held of ACC patients seen at a referral cancer center between February 1998 and August 2019. Clinical outcomes were compared between an early cohort (February 1998-June 2007) and a late cohort (July 2007-August 2019).

Results: A total of 621 patients included with a median age at diagnosis of 49.3 years (range, 0.5-86.6 years). There were 285 (45.9%) patients with hormonal overproduction. More patients in the late cohort had stage IV disease compared to the early cohort (36.8% vs 23.1%; P < .0001). Resection of the primary tumor was performed in 502 patients (80.8%). Complete resection (R0) was more common in the late cohort (165 [60.2%]) than in the early cohort (100 [44.6%]; P = .0005). Of 475 patients with metastatic disease (stage IV or recurrent metastatic disease), 352 (74.1%) received mitotane, 320 (67.4%) received chemotherapy, and 53 (11.2%) received immunotherapy. In the early cohort, 70 (33%) received 2 or more lines of therapy, whereas in the late cohort, 127 (48%) received 2 or more lines of therapy. The 5-year overall survival (OS) rates were 65%, 58%, 45%, and 10% for stage I, II, III, and IV disease, respectively, whereas the 2-year OS rates in patients with stage IV disease was 24% in the early cohort and 46% in the late cohort (P = .01).

Conclusion: ACC clinical outcomes improved over the past 2 decades as more patients had complete resection or received more lines of systemic therapy.

Keywords: adrenocortical carcinoma; immunotherapy; mitotane; recurrence; surgery; survival.

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Figures

Figure 1.
Figure 1.
The numbers of lines of systemic therapy received by the patients with metastatic adrenocortical carcinoma (stage IV or recurrent disease) (n = 475).
Figure 2.
Figure 2.
Overall survival time by adrenocortical carcinoma stage. A total of 621 patients: stage I (23, 3.7%), stage II (203, 33%), stage III (198, 32.1%), and stage IV disease (192, 31.2%).
Figure 3.
Figure 3.
A, Kaplan-Meier plot of recurrence-free survival (RFS) for patients who received adjuvant therapy after primary surgical resection (n = 145). B, Kaplan-Meier plot of RFS for patients who received neoadjuvant therapy (n = 29).
Figure 4.
Figure 4.
The proportion of patients presenting with stage IV disease (n = 192) and 2-year overall survival (OS) rate in these patients across time.
Figure 5.
Figure 5.
A and B illustrate the overall survival (OS) of stage IV patients based on diagnosis (Dx) year and based on the time of registration for the first visit at our institution, respectively.
Figure 6.
Figure 6.
Forest plot showing the results of multivariable analysis for overall survival (N = 621).
See this image and copyright information in PMC

References

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