TY - JOUR
T1 - Temporal Trends in Outcomes in Patients With Adrenocortical Carcinoma
T2 - A Multidisciplinary Referral-center Experience
AU - Daher, Marilyne
AU - Varghese, Jeena
AU - Gruschkus, Stephen K.
AU - Jimenez, Camilo
AU - Waguespack, Steven G.
AU - Bedrose, Sara
AU - Altameemi, Lina
AU - Bazerbashi, Hadil
AU - Naing, Aung
AU - Subaiah, Vivek
AU - Campbell, Matthew T.
AU - Shah, Amishi Y.
AU - Zhang, Miao
AU - Sheth, Rahul A.
AU - Karam, Jose A.
AU - Wood, Christopher G.
AU - Perrier, Nancy D.
AU - Graham, Paul H.
AU - Lee, Jeffery E.
AU - Habra, Mouhammed Amir
N1 - Publisher Copyright:
© 2022 The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Context: Reporting temporal trends in adrenocortical carcinoma (ACC) helps guide management strategies. Objective: This work aimed to report the trends in disease burden and clinical outcomes over time that cannot be adequately captured from individual clinical trials. Methods: A retrospective study was held of ACC patients seen at a referral cancer center between February 1998 and August 2019. Clinical outcomes were compared between an early cohort (February 1998-June 2007) and a late cohort (July 2007-August 2019). Results: A total of 621 patients included with a median age at diagnosis of 49.3 years (range, 0.5-86.6 years). There were 285 (45.9%) patients with hormonal overproduction. More patients in the late cohort had stage IV disease compared to the early cohort (36.8% vs 23.1%; P<.0001). Resection of the primary tumor was performed in 502 patients (80.8%). Complete resection (R0) was more common in the late cohort (165 [60.2%]) than in the early cohort (100 [44.6%]; P=.0005). Of 475 patients with metastatic disease (stage IV or recurrent metastatic disease), 352 (74.1%) received mitotane, 320 (67.4%) received chemotherapy, and 53 (11.2%) received immunotherapy. In the early cohort, 70 (33%) received 2 or more lines of therapy, whereas in the late cohort, 127 (48%) received 2 or more lines of therapy. The 5-year overall survival (OS) rates were 65%, 58%, 45%, and 10% for stage I, II, III, and IV disease, respectively, whereas the 2-year OS rates in patients with stage IV disease was 24% in the early cohort and 46% in the late cohort (P=.01). Conclusion: ACC clinical outcomes improved over the past 2 decades as more patients had complete resection or received more lines of systemic therapy.
AB - Context: Reporting temporal trends in adrenocortical carcinoma (ACC) helps guide management strategies. Objective: This work aimed to report the trends in disease burden and clinical outcomes over time that cannot be adequately captured from individual clinical trials. Methods: A retrospective study was held of ACC patients seen at a referral cancer center between February 1998 and August 2019. Clinical outcomes were compared between an early cohort (February 1998-June 2007) and a late cohort (July 2007-August 2019). Results: A total of 621 patients included with a median age at diagnosis of 49.3 years (range, 0.5-86.6 years). There were 285 (45.9%) patients with hormonal overproduction. More patients in the late cohort had stage IV disease compared to the early cohort (36.8% vs 23.1%; P<.0001). Resection of the primary tumor was performed in 502 patients (80.8%). Complete resection (R0) was more common in the late cohort (165 [60.2%]) than in the early cohort (100 [44.6%]; P=.0005). Of 475 patients with metastatic disease (stage IV or recurrent metastatic disease), 352 (74.1%) received mitotane, 320 (67.4%) received chemotherapy, and 53 (11.2%) received immunotherapy. In the early cohort, 70 (33%) received 2 or more lines of therapy, whereas in the late cohort, 127 (48%) received 2 or more lines of therapy. The 5-year overall survival (OS) rates were 65%, 58%, 45%, and 10% for stage I, II, III, and IV disease, respectively, whereas the 2-year OS rates in patients with stage IV disease was 24% in the early cohort and 46% in the late cohort (P=.01). Conclusion: ACC clinical outcomes improved over the past 2 decades as more patients had complete resection or received more lines of systemic therapy.
KW - adrenocortical carcinoma
KW - immunotherapy
KW - mitotane
KW - recurrence
KW - surgery
KW - survival
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U2 - 10.1210/clinem/dgac046
DO - 10.1210/clinem/dgac046
M3 - Article
C2 - 35092681
AN - SCOPUS:85128493851
SN - 0021-972X
VL - 107
SP - 1239
EP - 1246
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 5
ER -