PDF herunterladen
Horm Metab Res 2015; 47(11): 820-825
DOI: 10.1055/s-0035-1549877
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Impact of Regional Lymph Node Dissection on Disease Specific Survival in Adrenal Cortical Carcinoma[*]

N. Saade
1   University of Southern California Keck School of Medicine, Los Angeles, USA
,
C. Sadler
1   University of Southern California Keck School of Medicine, Los Angeles, USA
,
M. Goldfarb
2   John Wayne Cancer Institute at Providence St. John’s Health Center, Santa Monica, USA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 19. Januar 2015

accepted 26. März 2015

Publikationsdatum:
04. Mai 2015 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. The purpose of this study is to evaluate the impact of a more extensive regional lymph node dissection (LND) has on survival in ACC patients in the United States. Patients≥15 years of age without distant metastases who underwent surgical intervention for primary ACC were identified from the SEER18 registry from 1988–2009. Patients were divided into 2 groups: having a regional LND (≥ 5 LNs removed) vs. no-LND (0–4 LNs removed). Overall survival (OS) and disease specific survival (DSS) were compared between groups. Of 259 patients with complete data on nodal resection, 243 (93.8%) underwent no-LND and 16 (6.2%) LND. There was no difference in age, sex, metastases, or ENSAT stage between groups. However, LND patients had larger tumors (p=0.004), and more frequently underwent en-bloc surgery (p=0.002). One- and 3-year OS and DSS did not differ between groups. In a cox regression model, performance of a regional LND did not significantly influence DSS. However, female gender (HR: 1.67, CI: 1.04–2.69, p=0.033) and later stage (stage III-HR: 4.78, CI: 1.14–20.00, p=0.032) or positive LNs (HR: 5.92, CI: 2.05–17.08, p=0.001) were risk factors for worse DSS. Regional LND may not improve DSS or OS in nonmetastatic ACC patients undergoing adrenalectomy. It remains controversial as an essential part of the surgical management for ACC and deserves further investigation in a larger, prospective study. However, regional LND should still be considered for staging and prognostic purposes and to standardize surgical care.

Key words

adrenal cortical carcinoma (ACC) - lymph node dissection - disease specific survival

*  This paper was presented as a poster at the 99th Annual American College of Surgeons Meeting in Washington, DC, October 2014


 

  • References

  • 1 Bilimoria KY, Shen WT, Elaraj D, Bentrem DJ, Winchester DJ, Kebebew E, Sturgeon C. Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer 2008; 113: 3130-3136
    CrossrefPubMedSuche in Google Scholar
  • 2 Dackiw AP, Lee JE, Gagel RF, Evans DB. Adrenal cortical carcinoma. World J Surg 2001; 25: 914-926
    CrossrefPubMedSuche in Google Scholar
  • 3 Kendrick ML, Lloyd R, Erickson L, Farley DR, Grant CS, Thompson GB, Rowland C, Young WF, van Heerden JA. Adrenocortical carcinoma: surgical progress or status quo?. Arch Surg 2001; 136: 543-549
    CrossrefPubMedSuche in Google Scholar
  • 4 Schteingart DE, Doherty GM, Gauger PG, Giordano TJ, Hammer GD, Korobkin M, Worden FP. Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer 2005; 12: 667-680
    CrossrefPubMedSuche in Google Scholar
  • 5 Bellantone R, Ferrante A, Boscherini M, Lombardi CP, Crucitti P, Crucitti F, Favia G, Borrelli D, Boffi L, Capussotti L, Carbone G, Casaccia M, Cavallaro A, Del Gaudio A, Dettori G, Di Giovanni V, Mazziotti A, Marrano D, Masenti E, Miccoli P, Mosca F, Mussa A, Petronio R, Piat G, Marazano L. Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma. Surgery 1997; 122: 1212-1218
    CrossrefPubMedSuche in Google Scholar
  • 6 Grubbs EG, Callender GG, Xing Y, Perrier ND, Evans DB, Phan AT, Lee JE. Recurrence of adrenal cortical carcinoma following resection: surgery alone can achieve results equal to surgery plus mitotane. Ann Surg Oncol 2010; 17: 263-270
    PubMedSuche in Google Scholar
  • 7 Icard P, Goudet P, Charpenay C, Andreassian B, Carnaille B, Chapuis Y, Cougard P, Henry JF, Proye C. Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg 2001; 25: 891-897
    CrossrefPubMedSuche in Google Scholar
  • 8 Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol 1999; 6: 719-726
    CrossrefPubMedSuche in Google Scholar
  • 9 Pommier RF, Brennan MF. An eleven-year experience with adrenocortical carcinoma. Surgery 1992; 112: 963-970 discussion 970-961
    PubMedSuche in Google Scholar
  • 10 Gaujoux S, Brennan MF. Recommendation for standardized surgical management of primary adrenocortical carcinoma. Surgery 2012; 152: 123-132
    CrossrefPubMedSuche in Google Scholar
  • 11 Fassnacht M, Johanssen S, Quinkler M, Bucsky P, Willenberg HS, Beuschlein F, Terzolo M, Mueller HH, Hahner S, Allolio B. Group GACR, Tumors ENftSoA . Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma: proposal for a Revised TNM Classification. Cancer 2009; 115: 243-250
    CrossrefPubMedSuche in Google Scholar
  • 12 Libè R, Fratticci A, Bertherat J. Adrenocortical cancer: pathophysiology and clinical management. Endocr Relat Cancer 2007; 14: 13-28
    CrossrefPubMedSuche in Google Scholar
  • 13 Vather R, Sammour T, Kahokehr A, Connolly AB, Hill AG. Lymph node evaluation and long-term survival in Stage II and Stage III colon cancer: a national study. Ann Surg Oncol 2009; 16: 585-593
    CrossrefPubMedSuche in Google Scholar
  • 14 Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007; 99: 433-441
    CrossrefPubMedSuche in Google Scholar
  • 15 Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2001; 347: 1662-1669
    PubMedSuche in Google Scholar
  • 16 McCulloch P, Niita ME, Kazi H, Gama-Rodrigues JJ. Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer. Br J Surg 2005; 92: 5-13
    CrossrefPubMedSuche in Google Scholar
  • 17 Riall TS, Cameron JL, Lillemoe KD, Campbell KA, Sauter PK, Coleman J, Abrams RA, Laheru D, Hruban RH, Yeo CJ. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma – part 3: update on 5-year survival. J Gastrointest Surg 2005; 9: 1191-1204 discussion 1204–1196
    CrossrefPubMedSuche in Google Scholar
  • 18 Wong SL, Ji H, Hollenbeck BK, Morris AM, Baser O, Birkmeyer JD. Hospital lymph node examination rates and survival after resection for colon cancer. JAMA 2007; 298: 2149-2154
    CrossrefPubMedSuche in Google Scholar
  • 19 Gervasoni JE, Sbayi S, Cady B. Role of lymphadenectomy in surgical treatment of solid tumors: an update on the clinical data. Ann Surg Oncol 2007; 14: 2443-2462
    CrossrefPubMedSuche in Google Scholar
  • 20 Reibetanz J, Jurowich C, Erdogan I, Nies C, Rayes N, Dralle H, Behrend M, Allolio B, Fassnacht M. Group GAs . Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma. Ann Surg 2012; 255: 363-369
    CrossrefPubMedSuche in Google Scholar
  • 21 National Cancer Institute. Surveillance, Epidemiology, and End Results. http://www.seer.cancer.gov.libproxy.usc.edu/ accessed January 10 2013
    PubMedSuche in Google Scholar
  • 22 Lughezzani G, Sun M, Perrotte P, Jeldres C, Alasker A, Isbarn H, Budaus L, Shariat SF, Guazzoni G, Montorsi F, Karakiewicz PI. The European Network for the Study of Adrenal Tumors staging system is prognostically superior to the international union against cancer-staging system: a North American validation. Eur J Cancer 2010; 46: 713-719
    CrossrefPubMedSuche in Google Scholar
  • 23 Miller BS, Doherty GM. Regional lymphadenectomy for adrenocortical carcinoma. Ann Surgery 2013; 257: e13-e14
    CrossrefPubMedSuche in Google Scholar
  • 24 Sbiera S, Kroiss M, Thamm T, Beyer M, Majidi F, Kuehner D, Wobser M, Becker JC, Adam P, Ronchi C, Allolio B, Fassnacht M. Survivin in adrenocortical tumors – pathophysiological implications and therapeutic potential. Horm Metab Res 2013; 45: 137-146
    Thieme ConnectPubMedSuche in Google Scholar
  • 25 Bramann EL, Willenberg HS, Hildebrandt B, Muller-Mattheis V, Schott M, Scherbaum WA, Haase M. Griseofulvin inhibits the growth of adrenocortical cancer cells in vitro. Horm Metab Res 2013; 45: 297-300
    Thieme ConnectPubMedSuche in Google Scholar
  • 26 Lombardi CP, Raffaelli M, Boniardi M, De Toma G, Marzano LA, Miccoli P, Minni F, Morino M, Pelizzo MR, Pietrabissa A, Renda A, Valeri A, De Crea C, Bellantone R. Adrenocortical carcinoma: effect of hospital volume on patient outcome. Langenbeck’s Arch Surgery/Dtsch Ges Chirurg 2012; 397: 201-207
    PubMedSuche in Google Scholar
  • 27 Kerkhofs TM, Verhoeven RH, Bonjer HJ, van Dijkum EJ, Vriens MR, De Vries J, Van Eijck CH, Bonsing BA, Van de Poll-Franse LV, Haak HR, Dutch Adrenal N. Surgery for adrenocortical carcinoma in The Netherlands: analysis of the national cancer registry data. Eur J Endocrinol 2013; 169: 83-89
    CrossrefPubMedSuche in Google Scholar
  • 28 Ayala-Ramirez M, Jasim S, Feng L, Ejaz S, Deniz F, Busaidy N, Waguespack SG, Naing A, Sircar K, Wood CG, Pagliaro L, Jimenez C, Vassilopoulou-Sellin R, Habra MA. Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a tertiary care center. Eur J Endocrinol 2013; 169: 891-899
    CrossrefPubMedSuche in Google Scholar
  • 29 Canter DJ, Mallin K, Uzzo RG, Egleston BL, Simhan J, Walton J, Smaldone MC, Master VA, Bratslavsky G, Kutikov A. Association of tumor size with metastatic potential and survival in patients with adrenocortical carcinoma: an analysis of the National Cancer Database. Canad J Urol 2013; 20: 6915-6921
    PubMedSuche in Google Scholar
  • 30 Allolio B, Fassnacht M. Clinical review: Adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab 2006; 91: 2027-2037
    CrossrefPubMedSuche in Google Scholar
  • 31 Else T, Williams AR, Sabolch A, Jolly S, Miller BS, Hammer GD. Adjuvant therapies and patient and tumor characteristics associated with survival of adult patients with adrenocortical carcinoma. J Clin Endocrinol Metab 2014; 99: 455-461
    CrossrefPubMedSuche in Google Scholar
  • 32 Habra MA, Ejaz S, Feng L, Das P, Deniz F, Grubbs EG, Phan A, Waguespack SG, Ayala-Ramirez M, Jimenez C, Perrier ND, Lee JE, Vassilopoulou-Sellin R. A retrospective cohort analysis of the efficacy of adjuvant radiotherapy after primary surgical resection in patients with adrenocortical carcinoma. J Clin Endocrinol Metab 2013; 98: 192-197
    CrossrefPubMedSuche in Google Scholar
  • 33 Fassnacht M, Hahner S, Polat B, Koschker AC, Kenn W, Flentje M, Allolio B. Efficacy of adjuvant radiotherapy of the tumor bed on local recurrence of adrenocortical carcinoma. The Journal of clinical endocrinology and metabolism 2006; 91: 4501-4504
    CrossrefPubMedSuche in Google Scholar
  • 34 Sabolch A, Feng M, Griffith K, Hammer G, Doherty G, Ben-Josef E. Adjuvant and definitive radiotherapy for adrenocortical carcinoma. International journal of radiation oncology, biology, physics 2011; 80: 1477-1484
    CrossrefPubMedSuche in Google Scholar