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HPB (Oxford). 2019 Aug 22. pii: S1365-182X(19)30616-1. doi: 10.1016/j.hpb.2019.07.002. [Epub ahead of print]

Disease-free interval and tumor functional status can be used to select patients for resection/ablation of liver metastases from adrenocortical carcinoma: insights from a multi-institutional study.

Author information

1
Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
2
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
3
Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
4
Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
5
Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: jonathan.hernandez@nih.gov.

Abstract

BACKGROUND:

Adrenocortical carcinoma (ACC) is an aggressive malignancy that frequently metastasizes to the liver. Given the limitations of systemic therapy in this setting, we sought to determine characteristics associated with a two-fold increase in survival with resection/ablation compared to that reported with chemotherapy alone (∼12 months).

METHODS:

Patients who underwent resection/ablation at our institutions for ACC liver metastases were identified. Those who survived 12-24 months after metastasectomy were excluded, as the aim was to characterize patients who most clearly benefited from these procedures. Clinicopathologic and treatment characteristics were assessed for associations with survival.

RESULTS:

Sixty-two patients met inclusion criteria, of whom 44 survived >24 months and 18 survived <12 months. Patients with extended survival were less likely to have functioning tumors (p = 0.047), had fewer liver metastases (p = 0.047), and a longer disease-free interval (DFI) (median 17.6 vs 2.3 months, p < 0.0001). On multivariable analysis, DFI (OR = 1.33, 95% CI = 1.12-1.58) and non-functioning tumor (OR = 0.13, 95% CI = 0.13-0.56) were independently associated with prolonged survival.

CONCLUSION:

Metastasectomy/ablation should be considered for patients with ACC liver metastases. DFI and tumor functional status may be useful in selecting optimal candidates for these procedures.

PMID:
31447392
DOI:
10.1016/j.hpb.2019.07.002

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