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Adrenocortical Carcinoma: Impact of Surgical Margin Status on Long-Term Outcomes

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The influence of surgical margin status on long-term outcomes of patients undergoing adrenal resection for ACC remains not well defined. We studied the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ACC.

Methods

A total of 165 patients who underwent adrenal resection for ACC and met inclusion criteria were identified form a multi-institutional database. Clinicopathological data, pathologic margin status, and long-term outcomes were assessed. Patients were stratified into two groups based on margin status: R0 (margin >1 mm) versus R1.

Results

R0 resection was achieved in 126 patients (76.4 %), whereas 39 patients (23.6 %) had an R1 resection. Median and 5-year OS for patients undergoing R0 resection were 96.3 months and 64.8 % versus 25.1 months and 33.8 % for patients undergoing an R1 resection (both p < 0.001). On multivariable analysis, surgical margin status was an independent predictor of worse OS (hazard ratio [HR] 2.22, 95 % confidence interval [CI] 1.03–4.77; p = 0.04). The incidence of recurrence also differed between the two groups; 5-year RFS was 30.3 % among patients with an R0 resection versus 13.8 % among patients who had an R1 resection (p = 0.03). Lymph node metastasis (N1) was an independent predictor of RFS (HR 2.70, 95 % CI 1.04–6.99; p = 0.04).

Conclusions

A positive margin after ACC resection was associated with worse long-term survival. Patient selection and an emphasis on surgical technique to achieve R0 margins are pivotal to optimizing the best chance for long-term outcome among patients with ACC.

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Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Georgios Antonios Margonis MD, PhD, Yuhree Kim MD, MPH, Jason D. Prescott MD, PhD & Timothy M. Pawlik MD, MPH, PhD

  2. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Thuy B. Tran MD & George A. Poultsides MD

  3. Department of Surgery, Emory University, Atlanta, GA, USA

    Lauren M. Postlewait MD & Shishir K. Maithel MD

  4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Tracy S. Wang MD, MPH & Douglas B. Evans MD

  5. Department of Surgery, New York University School of Medicine, New York, NY, USA

    Ioannis Hatzaras MD, MPH & Rivfka Shenoy MD

  6. Department of Surgery, The Ohio State University, Columbus, OH, USA

    John E. Phay MD & Kara Keplinger MD

  7. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ryan C. Fields MD & Linda X. Jin MD

  8. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD & Ahmed Salem MD

  9. Department of Surgery, University of California San Diego, San Diego, CA, USA

    Jason K. Sicklick MD & Shady Gad MD

  10. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Adam C. Yopp MD & John C. Mansour MD

  11. Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Quan-Yang Duh MD & Natalie Seiser MD, PhD

  12. Department of Surgery, Vanderbilt University, Nashville, TN, USA

    Carmen C. Solorzano MD & Colleen M. Kiernan MD

  13. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos MD & Edward A. Levine MD

Authors
  1. Georgios Antonios Margonis MD, PhD
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  2. Yuhree Kim MD, MPH
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  3. Jason D. Prescott MD, PhD
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  6. Shishir K. Maithel MD
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  9. Ioannis Hatzaras MD, MPH
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  13. Ryan C. Fields MD
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  14. Linda X. Jin MD
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  15. Sharon M. Weber MD
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  16. Ahmed Salem MD
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  17. Jason K. Sicklick MD
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  18. Shady Gad MD
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  19. Adam C. Yopp MD
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  20. John C. Mansour MD
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  21. Quan-Yang Duh MD
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  22. Natalie Seiser MD, PhD
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  23. Carmen C. Solorzano MD
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  24. Colleen M. Kiernan MD
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  25. Konstantinos I. Votanopoulos MD
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  26. Edward A. Levine MD
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  27. George A. Poultsides MD
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  28. Timothy M. Pawlik MD, MPH, PhD
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Margonis, G.A., Kim, Y., Prescott, J.D. et al. Adrenocortical Carcinoma: Impact of Surgical Margin Status on Long-Term Outcomes. Ann Surg Oncol 23, 134–141 (2016). https://doi.org/10.1245/s10434-015-4803-x

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  • DOI: https://doi.org/10.1245/s10434-015-4803-x

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