Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group |
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Authors: | Icard P Goudet P Charpenay C Andreassian B Carnaille B Chapuis Y Cougard P Henry J F Proye C |
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Institution: | Service de Chirurgie Viscérale et Urgences, H?pital Général, 3 Rue du Faubourg-Raines, BP 1519, 21033 Dijon, France. pierre.goudet@chu-dijon.fr |
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Abstract: | Because of the rarity of adrenocortical carcinoma, survival rates and the prognosis for patients who have undergone operation
are not well known. The purpose of the French Association of Endocrine Surgery was to evaluate these factors over an 18-year
period. A trend study was associated to assess changes in the clinical and biochemical presentations as well as the surgical
evolution. A total of 253 patients (158 women, 95 men) with a mean age of 47 years were included. Cushing syndrome was the
main clinical presentation (30%), and hormonal studies revealed secreting tumors in 66% of the cases. Altogether, 72% (n= 182) of patients underwent resection for cure, and 41.5% (n= 105) of them had an extensive resection because of metastatic cancer. A lymphadenectomy was performed in 32.5% (n= 89) of the cases. The operative mortality was 5.5% (n= 14). Patients were given mitotane as adjuvant therapy in 53.8% of the cases (n= 135). The results of staging were stage I in 16 patients (6.3%), stage II (local disease) in 126 patients (49.8%), stage
III (locoregional disease) in 57 patients (22.5%), and stage IV (metastases) in 54 patients (21.3%). Neither tumor staging
nor the rate of curative surgery changed during the study period. More subcostal incisions were performed, and the use of
mitotane increased significantly. The 5-year actuarial survival rates were 38% overall, 50% in the curative group, 66% for
stage I, 58% for stage II, 24% for stage III, and 0% for stage IV. Multivariate analysis showed that mitotane benefited only
the group of patients not operated on for cure. A better prognosis was found in patients operated on after 1988 (p= 0.04), in those with precursor-secreting tumors (p= 0.005), and in those at local stages of the disease (p= 0.0003). Thus mitotane benefited only patients not operated on for cure. Curative resection, precursor secretion, recent
diagnosis, and local stage were favorably associated with survival. |
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