The effect of hormonal secretion on survival in adrenocortical carcinoma: A multi-center study

Alaa Sada¹, Trenton R Foster², Ruaa Al-Ward³, Sahar Sawani⁴, HElaine Charchar⁵, Reza Pishdad⁶, Anat Ben-Shlomo⁷, Benzon M Dy⁸, Melanie L Lyden², Emily Bergsland⁹, Sina Jasim¹⁰, Nitya Raj¹¹, Jessica B Shank¹², Oksana Hamidi¹³, Amir H Hamrahian¹⁴, José L Chambô¹⁵, Victor Srougi¹⁶, Maria Cbv Fragoso¹⁷, Paul H Graham¹⁸, Mouhammed Amir Habra³, Irina Bancos¹⁹, Travis J McKenzie²⁰

Affiliations

¹ Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: https://twitter.com/Aabdusada.
² Department of Surgery, Mayo Clinic, Rochester, MN.
³ Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX.
⁴ Department of Medicine, Baylor College of Medicine, Houston, TX.
⁵ Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
⁶ Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, MD. Electronic address: https://twitter.com/rpishdad.
⁷ Adrenal Program, Division of Endocrinology, Diabetes, and Metabolism, Cedars Sinai Medical Center, Los Angeles, CA.
⁸ Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: https://twitter.com/Benzon_dy.
⁹ Department of Medicine, University of California San Francisco, San Francisco, CA.
¹⁰ Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, Saint Louis, MO. Electronic address: https://twitter.com/Sina_jasim.
¹¹ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
¹² Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE.
¹³ Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX.
¹⁴ Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, MD.
¹⁵ Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹⁶ Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Hospital Moriah, São Paulo, Brazil.
¹⁷ Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: https://twitter.com/Fragoso_mc.
¹⁸ Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
¹⁹ Division of Endocrinology, Mayo Clinic, Rochester, MN. Electronic address: Bancos.Irina@mayo.edu.
²⁰ Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: Mckenzie.Travis@mayo.edu.

PMID: 37945477
DOI: 10.1016/j.surg.2023.04.070

Multicenter Study

The effect of hormonal secretion on survival in adrenocortical carcinoma: A multi-center study

Alaa Sada et al. Surgery. 2024 Jan.

. 2024 Jan;175(1):80-89.

doi: 10.1016/j.surg.2023.04.070. Epub 2023 Nov 8.

Authors

Affiliations

¹ Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: https://twitter.com/Aabdusada.
² Department of Surgery, Mayo Clinic, Rochester, MN.
³ Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX.
⁴ Department of Medicine, Baylor College of Medicine, Houston, TX.
⁵ Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
⁶ Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, MD. Electronic address: https://twitter.com/rpishdad.
⁷ Adrenal Program, Division of Endocrinology, Diabetes, and Metabolism, Cedars Sinai Medical Center, Los Angeles, CA.
⁸ Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: https://twitter.com/Benzon_dy.
⁹ Department of Medicine, University of California San Francisco, San Francisco, CA.
¹⁰ Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, Saint Louis, MO. Electronic address: https://twitter.com/Sina_jasim.
¹¹ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
¹² Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE.
¹³ Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX.
¹⁴ Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, MD.
¹⁵ Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹⁶ Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Hospital Moriah, São Paulo, Brazil.
¹⁷ Unidade de Suprarrenal, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: https://twitter.com/Fragoso_mc.
¹⁸ Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
¹⁹ Division of Endocrinology, Mayo Clinic, Rochester, MN. Electronic address: Bancos.Irina@mayo.edu.
²⁰ Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: Mckenzie.Travis@mayo.edu.

PMID: 37945477
DOI: 10.1016/j.surg.2023.04.070

Abstract

Background: Current evidence suggests that cortisol secreting adrenocortical carcinoma has worse prognosis compared to non-secreting adrenocortical carcinoma. However, the effect of other secretory subtypes is unknown.

Methods: This multicenter study within the American-Australian-Asian Adrenal Alliance included adults with adrenocortical carcinoma (1997-2020). We compared overall survival and disease-free survival among cortisol secreting, mixed cortisol/androgen secreting, androgen secreting, and non-secreting adrenocortical carcinoma.

Results: Of the 807 patients (mean age 50), 719 included in the secretory subtype analysis: 24.5% were cortisol secreting, 13% androgen secreting, 28% mixed cortisol/androgen, 32.5% non-secreting, and 2% were mineralocorticoid secreting. Median overall survival and disease-free survival for the entire cohort were 60 and 9 months, respectively. Median overall survival was 36 months for cortisol, 30 for mixed, 60 for androgen secreting, and 115 for non-secreting adrenocortical carcinoma, P < .01. Median disease-free survival was 7 months for cortisol, 8 for mixed, 10 for androgen, and 12 for non-secreting adrenocortical carcinoma, P = .06. On multivariable analysis of age, sex, Ki67%, secretory subtype, stage, resection, and adjuvant therapy, predictors of worse overall survival were older age, higher Ki67%, stage IV, mixed secreting, R1, and no adjuvant therapy, P < .05. On subgroup analysis of R0 resection, predictors of worse overall survival included older age and higher Ki67%. Ki67% ≥40, stage III and cortisol secretion were associated with worse disease-free survival.

Conclusion: Mixed cortisol/androgen secreting adrenocortical carcinoma was associated with worse overall survival, while cortisol or androgen secreting alone were not. Notably, among patients after R0 resection, secretory subtype did not affect overall survival. Cortisol secreting adrenocortical carcinoma demonstrated worse disease-free survival. Ki67% remained a strong predictor of worse overall survival and disease-free survival independent of stage.

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The effect of hormonal secretion on survival in adrenocortical carcinoma: A multi-center study

Affiliations

The effect of hormonal secretion on survival in adrenocortical carcinoma: A multi-center study

Authors

Affiliations

Abstract

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LinkOut - more resources

Full Text Sources