Japanese Journal of Clinical Oncology Advance Access published online on February 2, 2007
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyl127
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© 2007 Foundation for Promotion of Cancer Research
Surgical Outcome of Stage III and IV Adrenocortical Carcinoma
1 Department of Surgery, Gunma University Graduate School of Medicine, Maebashi
2 Department of Surgery, Sudo Hospital, Annaka, Gunma
3 Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan
For reprints and all correspondence: Susumu Ohwada, Department of Surgery, Gunma University School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma 371, Japan. E-mail: sohwada{at}med.gunma-u.ac.jp
Received July 21, 2006; accepted September 23, 2006
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare tumor usually diagnosed at an advanced stage on invasion of or adherence to adjacent organs. We report surgical outcome of stage III and IV ACCs.
METHODS: ACCs from seven patients at clinical stage II (n = 1), III (n = 4), or IV (n = 2) were resected. Combined resection of the liver and inferior vena cava was performed in six patients. Morbidity, mortality, recurrence and survival were analyzed.
RESULTS: The pathological stage was stage III in five patients and stage IV in two patients. The mortality was zero and the morbidity was two of seven (29%) patients. The estimated 3-year disease-free and overall survivals for stage III were 20% and 40%, respectively, with a median follow-up of 32 months (range, 11–58). The mean disease-free survival was 21.0 ± 9.0 months (95% CI: 3.3–38.7). The 3-year disease-free and overall survivals for stage III and IV were 14.3% and 28.6%, respectively. The mean disease-free survival time was 18.6 ± 6.7 months (95% CI: 5.4–31.8). The most frequent site of metastasis was the lungs, seen in four patients, and liver in three patients. Loco-regional, intra-abdominal lymph node, peritoneum, bone, brain recurrences were also seen in one patient each. The mean survival after recurrence was 19.0 ± 3.3 months (95% CI: 12.6–25.5), and the 50% survival was 18.4 months with mitotan and cytotoxic drug therapy.
CONCLUSIONS: Resection for stage III, IV ACCs affords the possibility of negative margins, acceptable peri-operative morbidity and mortality, and prolongs survival in selected patients.
Key Words: adrenocortical carcinoma • inferior vena cava (IVC) replacement • liver resection • IVC resection • stage III • stage IV