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Outcomes after resection of cortisol-secreting adrenocortical carcinoma.

  • Author(s): Margonis, Georgios Antonios
  • Kim, Yuhree
  • Tran, Thuy B
  • Postlewait, Lauren M
  • Maithel, Shishir K
  • Wang, Tracy S
  • Glenn, Jason A
  • Hatzaras, Ioannis
  • Shenoy, Rivfka
  • Phay, John E
  • Keplinger, Kara
  • Fields, Ryan C
  • Jin, Linda X
  • Weber, Sharon M
  • Salem, Ahmed
  • Sicklick, Jason K
  • Gad, Shady
  • Yopp, Adam C
  • Mansour, John C
  • Duh, Quan-Yang
  • Seiser, Natalie
  • Solorzano, Carmen C
  • Kiernan, Colleen M
  • Votanopoulos, Konstantinos I
  • Levine, Edward A
  • Poultsides, George A
  • Pawlik, Timothy M
  • et al.
Abstract

We sought to define the impact of cortisol-secreting status on outcomes after surgical resection of adrenocortical carcinoma (ACC).The U.S ACC group database was queried to identify patients who underwent ACC resection between 1993 and 2014. The short-term and long-term outcomes were assessed.The incidence of all functional and cortisol-secreting tumors was 40.6% and 22.6%, respectively. On multivariable analysis, cortisol secretion remained associated with an increased risk of postoperative complications (odds ratio = 2.25, 95 % confidence interval = 1.04 to 4.88; P = .04). At a median follow-up of 17.6 months, 118 patients (50.4%) had developed a recurrence. On multivariable analysis, after adjusting for patient and disease-related factors cortisol secretion independently predicted shorter recurrence-free survival (Hazard ratio = 2.05, 95% confidence interval = 1.16 to 3.60; P = .01).Cortisol secretion was associated with an increased risk of postoperative morbidity. Recurrence remains high among patients with ACC after surgery; cortisol secretion was independently associated with a shorter recurrence-free survival. Tailoring postoperative surveillance of ACC patients based on their cortisol secreting status may be important.

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