Adrenocortical carcinoma - Surgical progress or status quo?

Hypothesis: Outcome of patients with adrenocortical carcinoma (ACC) has imp roved with the advent of more widely available and higher quality imaging. Operative management strategies and use of adjuvant therapy have not change d. Design: Retrospective review of patient histories, imaging studies, operati ve data, adjuvant therapy, and outcomes at a single institution. Follow-up was complete for a mean of 53 months. Data was compared with prior institut ional experience. Setting: Tertiary care referral center. Patients: All patients undergoing operative management for ACC during the p eriod from 1980 to 1996. Main Outcome Measures: Determinants of recurrence, survival, and the effect of adjuvant therapy on overall outcome. Results: Fifty-eight patients (30 men, 28 women) with a mean age of 53 year s underwent primary operative e management for ACC. Functional tumors were identified in 27 patients (47%). Mean tumor size was 12.5 cm. Stage accordi ng to the TNM staging system (AJCC Cancer Staging Manual) at presentation w as I (n=0), II (n=30), III (n=7), and IV (n=21). Surgical management includ ed curative resection in 41 (71%), noncurative resection in 14 (24%), and o pen biopsy in 3 (5%). Perioperative mortality was 5%. Recurrence occurred i n 30 patients (73%) with a median time to recurrence of 17 months. Five yea r survival by the Kaplan-Meier method was 37%. Prognostic factors (P<.05) i ncluded functional status, stage, and chemotherapy in stage III/IV patients . When compared with our prior institutional experience (1960-1980), curren t patients were more likely to present with stages 1 to 11 (52% vs 34%), ha ve curative resections (71% vs 50%), and have improved 5-year survival (37% vs 16%). Conclusions: (1) Surgical resection remains the principal treatment for sta ge I to III disease. (2) Adjuvant therapy may improve survival in patients with stage III or IV disease. (3) Current patients were more likely to pres ent at an earlier stage, undergo curative resections, and have improved 5-y ear survival than institutional historical comparisons.