Resection of adrenocortical carcinoma liver metastasis: Is it justified? Journal Article

  


Authors: Gaujoux, S.; Al-Ahmadie, H.; Allen, P. J.; Gonen, M.; Shia, J.; D'Angelica, M.; DeMatteo, R.; Fong, Y.; Blumgart, L.; Jarnagin, W. R.
Article Title: Resection of adrenocortical carcinoma liver metastasis: Is it justified?
Abstract: Background: Adrenocortical carcinoma (ACC) liver metastases (LM) represent a therapeutic challenge, and it is unclear whether resection is justified. This study assesses long-term outcome and prognostic factors after liver resection for metastatic ACC. Methods: Patients who underwent resection of ACC LM were identified from institutional databases. Recurrence, survival, and tumor characteristics, including β-catenin and TP53 status based on immunohistochemistry and sequencing, were reviewed. The prognostic value of variables was assessed with log-rank test for univariate analysis and Cox proportional hazard models for multivariate analysis. Results: From 1978 to 2009, 28 patients (20 females; median age, 45 years), including 11 with synchronous metastasis and 3 with extrahepatic metastasis, underwent resection for ACC LM (major hepatectomy in 61%). Postoperative mortality was nil and morbidity 55%. On pathological examination, tumors were multiple in 68%, with a median size of 43 mm, and resections were R0, 1, and 2 in 59%, 33%, and 7%, respectively. All 28 patients developed recurrent disease, which was treated surgically in 11, including repeat hepatectomy in 4. Of the 15 patients with adequate tissue for analysis, β-catenin immunostaining was positive in 7, with 4 corresponding CTNNB1 mutations associated with decreased survival; p53 staining was positive in 5 (4 with corresponding TP53 mutations). The median disease-free and overall survival after hepatectomy was 7 and 31.5 months, respectively, with a 5-year survival of 39%. In multivariate analysis, nonfunctional tumor and surgical treatment of recurrence were independent predictors of good outcome. Conclusions: In selected patients with ACC LM, resection is associated with long-term survival and is, therefore, justified but rarely curative. © 2012 Society of Surgical Oncology.
Keywords: immunohistochemistry; adult; cancer survival; clinical article; protein expression; treatment outcome; middle aged; cancer surgery; survival rate; retrospective studies; gene mutation; overall survival; mutation; histopathology; liver neoplasms; disease free survival; follow up; follow-up studies; neoplasm staging; polymerase chain reaction; tumor localization; neoplasm recurrence, local; tumor volume; morbidity; tumor markers, biological; protein p53; adrenal cortex carcinoma; postoperative complication; immunoenzyme techniques; liver metastasis; amino acid sequence; tumor recurrence; dna, neoplasm; operation duration; tumor suppressor protein p53; liver resection; surgical mortality; hepatectomy; wnt proteins; beta catenin; adrenocortical carcinoma; adrenal cortex neoplasms; cancer prognosis
Journal Title: Annals of Surgical Oncology
Volume: 19
Issue: 8
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2012-08-01
Start Page: 2643
End Page: 2651
Language: English
DOI: 10.1245/s10434-012-2358-7
PROVIDER: scopus
PUBMED: 22526905
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-84865024540&partnerID=40&md5=1c4f6b0c004a2267474f02c8d00f90ee
Notes: --- - "Export Date: 4 September 2012" - "CODEN: ASONF" - "Source: Scopus"
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MSK Authors
  1. Leslie H Blumgart
    352 Blumgart
  2. Ronald P DeMatteo
    637 DeMatteo
  3. Mithat Gonen
    1028 Gonen
  4. Jinru Shia
    714 Shia
  5. Peter Allen
    501 Allen
  6. William R Jarnagin
    903 Jarnagin
  7. Yuman Fong
    775 Fong
  8. Michael D'Angelica
    777 D'Angelica
  9. Sebastien Gaujoux
    11 Gaujoux
  10. Hikmat Al-Ahmadie
    655 Al-Ahmadie
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