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.

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.

• Authors: Reed I Ayabe, Raja R Narayan, Samantha M Ruff, Michael M Wach, Winifred Lo, Pieter M H Nierop, Seth M Steinberg, R Taylor Ripley, Jeremy L Davis, Bas G Koerkamp, Michael I D'Angelica, T Peter Kingham, William R Jarnagin, Jonathan M Hernandez
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 22 Issue 1 Pg. 169-175 (01 2020) ISSN: 1477-2574 [Electronic] England
• PMID: 31447392 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Intramural)
• Copyright: Published by Elsevier Ltd.

Topics

• Adrenal Cortex Neoplasms (mortality, pathology, therapy)
• Adrenocortical Carcinoma (mortality, secondary, surgery)
• Adult
• Disease-Free Survival
• Female
• Hepatectomy
• Humans
• Liver Neoplasms (mortality, secondary, surgery)
• Male
• Metastasectomy
• Middle Aged
• Patient Selection
• Radiofrequency Ablation
• Retrospective Studies
• Survival Rate