Adrenocortical Carcinoma: Impact of Surgical Margin Status on Long-Term Outcomes
- Margonis, GA;
- Kim, Y;
- Prescott, JD;
- Tran, TB;
- Postlewait, LM;
- Maithel, SK;
- Wang, TS;
- Evans, DB;
- Hatzaras, I;
- Shenoy, R;
- Phay, JE;
- Keplinger, K;
- Fields, RC;
- Jin, LX;
- Weber, SM;
- Salem, A;
- Sicklick, JK;
- Gad, S;
- Yopp, AC;
- Mansour, JC;
- Duh, QY;
- Seiser, N;
- Solorzano, CC;
- Kiernan, CM;
- Votanopoulos, KI;
- Levine, EA;
- Poultsides, GA;
- Pawlik, TM
- et al.
Published Web Location
http://download.springer.com/static/pdf/147/art%253A10.1245%252Fs10434-015-4803-x.pdf?originUrl=http://link.springer.com/article/10.1245/s10434-015-4803-x&token2=exp=1487375580~acl=/static/pdf/147/art%25253A10.1245%25252Fs10434-015-4803-x.pdf?originUrl=http%253A%252F%252Flink.springer.com%252Farticle%252F10.1245%252Fs10434-015-4803-x*~hmac=e9d3544a047433dc3f923ffeae16fb6e2f69943062b341a6912225188d060e61Abstract
Background: The influence of surgical margin status on long-term outcomes of patients undergoing adrenal resection for ACC remains not well defined. We studied the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ACC. Methods: A total of 165 patients who underwent adrenal resection for ACC and met inclusion criteria were identified form a multi-institutional database. Clinicopathological data, pathologic margin status, and long-term outcomes were assessed. Patients were stratified into two groups based on margin status: R0 (margin >1 mm) versus R1. Results: R0 resection was achieved in 126 patients (76.4 %), whereas 39 patients (23.6 %) had an R1 resection. Median and 5-year OS for patients undergoing R0 resection were 96.3 months and 64.8 % versus 25.1 months and 33.8 % for patients undergoing an R1 resection (both p < 0.001). On multivariable analysis, surgical margin status was an independent predictor of worse OS (hazard ratio [HR] 2.22, 95 % confidence interval [CI] 1.03–4.77; p = 0.04). The incidence of recurrence also differed between the two groups; 5-year RFS was 30.3 % among patients with an R0 resection versus 13.8 % among patients who had an R1 resection (p = 0.03). Lymph node metastasis (N1) was an independent predictor of RFS (HR 2.70, 95 % CI 1.04–6.99; p = 0.04). Conclusions: A positive margin after ACC resection was associated with worse long-term survival. Patient selection and an emphasis on surgical technique to achieve R0 margins are pivotal to optimizing the best chance for long-term outcome among patients with ACC.
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