TY - JOUR
T1 - Outcomes of Adjuvant Mitotane after Resection of Adrenocortical Carcinoma
T2 - A 13-Institution Study by the US Adrenocortical Carcinoma Group
AU - Postlewait, Lauren M.
AU - Ethun, Cecilia G.
AU - Tran, Thuy B.
AU - Prescott, Jason D.
AU - Pawlik, Timothy M.
AU - Wang, Tracy S.
AU - Glenn, Jason
AU - Hatzaras, Ioannis
AU - Shenoy, Rivfka
AU - Phay, John E.
AU - Keplinger, Kara
AU - Fields, Ryan C.
AU - Jin, Linda X.
AU - Weber, Sharon M.
AU - Salem, Ahmed
AU - Sicklick, Jason K.
AU - Gad, Shady
AU - Yopp, Adam C.
AU - Mansour, John C.
AU - Duh, Quan Yang
AU - Seiser, Natalie
AU - Solorzano, Carmen C.
AU - Kiernan, Colleen M.
AU - Votanopoulos, Konstantinos I.
AU - Levine, Edward A.
AU - Staley, Charles A.
AU - Poultsides, George A.
AU - Maithel, Shishir K.
N1 - Funding Information:
Support: This study was supported in part by the Katz Foundation.
Funding Information:
Support: This study was supported in part by the Katz Foundation.
Publisher Copyright:
© 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background Current treatment guidelines recommend adjuvant mitotane after resection of adrenocortical carcinoma with high-risk features (eg, tumor rupture, positive margins, positive lymph nodes, high grade, elevated mitotic index, and advanced stage). Limited data exist on the outcomes associated with these practice guidelines. Study Design Patients who underwent resection of adrenocortical carcinoma from 1993 to 2014 at the 13 academic institutions of the US Adrenocortical Carcinoma Group were included. Factors associated with mitotane administration were determined. Primary end points were recurrence-free survival (RFS) and overall survival (OS). Results Of 207 patients, 88 (43%) received adjuvant mitotane. Receipt of mitotane was associated with hormonal secretion (58% vs 32%; p = 0.001), advanced TNM stage (stage IV: 42% vs 23%; p = 0.021), adjuvant chemotherapy (37% vs 5%; p < 0.001), and adjuvant radiation (17% vs 5%; p = 0.01), but was not associated with tumor rupture, margin status, or N-stage. Median follow-up was 44 months. Adjuvant mitotane was associated with decreased RFS (10.0 vs 27.9 months; p = 0.007) and OS (31.7 vs 58.9 months; p = 0.006). On multivariable analysis, mitotane was not independently associated with RFS or OS, and margin status, advanced TNM stage, and receipt of chemotherapy were associated with survival. After excluding all patients who received chemotherapy, adjuvant mitotane remained associated with decreased RFS and similar OS; multivariable analyses again showed no association with recurrence or survival. Stage-specific analyses in both cohorts revealed no association between adjuvant mitotane and improved RFS or OS. Conclusions When accounting for stage and adverse tumor and treatment-related factors, adjuvant mitotane after resection of adrenocortical carcinoma is not associated with improved RFS or OS. Current guidelines should be revisited and prospective trials are needed.
AB - Background Current treatment guidelines recommend adjuvant mitotane after resection of adrenocortical carcinoma with high-risk features (eg, tumor rupture, positive margins, positive lymph nodes, high grade, elevated mitotic index, and advanced stage). Limited data exist on the outcomes associated with these practice guidelines. Study Design Patients who underwent resection of adrenocortical carcinoma from 1993 to 2014 at the 13 academic institutions of the US Adrenocortical Carcinoma Group were included. Factors associated with mitotane administration were determined. Primary end points were recurrence-free survival (RFS) and overall survival (OS). Results Of 207 patients, 88 (43%) received adjuvant mitotane. Receipt of mitotane was associated with hormonal secretion (58% vs 32%; p = 0.001), advanced TNM stage (stage IV: 42% vs 23%; p = 0.021), adjuvant chemotherapy (37% vs 5%; p < 0.001), and adjuvant radiation (17% vs 5%; p = 0.01), but was not associated with tumor rupture, margin status, or N-stage. Median follow-up was 44 months. Adjuvant mitotane was associated with decreased RFS (10.0 vs 27.9 months; p = 0.007) and OS (31.7 vs 58.9 months; p = 0.006). On multivariable analysis, mitotane was not independently associated with RFS or OS, and margin status, advanced TNM stage, and receipt of chemotherapy were associated with survival. After excluding all patients who received chemotherapy, adjuvant mitotane remained associated with decreased RFS and similar OS; multivariable analyses again showed no association with recurrence or survival. Stage-specific analyses in both cohorts revealed no association between adjuvant mitotane and improved RFS or OS. Conclusions When accounting for stage and adverse tumor and treatment-related factors, adjuvant mitotane after resection of adrenocortical carcinoma is not associated with improved RFS or OS. Current guidelines should be revisited and prospective trials are needed.
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U2 - 10.1016/j.jamcollsurg.2015.12.013
DO - 10.1016/j.jamcollsurg.2015.12.013
M3 - Article
C2 - 26775162
AN - SCOPUS:84962376501
SN - 1072-7515
VL - 222
SP - 480
EP - 490
JO - Surgery Gynecology and Obstetrics
JF - Surgery Gynecology and Obstetrics
IS - 4
ER -