Prognostic predictors of adrenocortical carcinoma: A single-center thirty-year experience

Li-Hsin Pan; Chueh-Chuan Yen; Chun-Jui Huang; Xin-Ning Ng; Liang-Yu Lin

doi:10.3389/fendo.2023.1134643

Prognostic predictors of adrenocortical carcinoma: A single-center thirty-year experience

Front Endocrinol (Lausanne). 2023 Mar 10:14:1134643. doi: 10.3389/fendo.2023.1134643. eCollection 2023.

Authors

Li-Hsin Pan^{1

2}, Chueh-Chuan Yen^{2

3

4

5}, Chun-Jui Huang^{1

2}, Xin-Ning Ng^{1

6}, Liang-Yu Lin^{1

2}

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Division of Medical Oncology, Center for Immuno-oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Institute of Biopharmaceutical Sciences, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁶ Division of Endocrinology and Metabolism, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Chiayi, Taiwan.

Abstract

Background: The prognosis of adrenocortical carcinoma (ACC) is poor but highly variable. The present study aimed to characterize patients with ACC at a single center in Taiwan and to determine the prognostic predictors of overall and progression-free survival.

Methods: Medical records of patients, who were diagnosed with ACC at Taipei Veterans General Hospital between January 1992 and June 2021, were reviewed. Patient demographics, tumor characteristics, and subsequent treatment were analyzed with regard to overall survival and progression-free survival using Kaplan-Meier methods and a Cox regression model.

Results: Sixty-seven patients were included. Females (65.7%) were more susceptible to ACC, with a younger onset and active hormonal secretion. One-half of the patients exhibited distant metastases at the time of diagnosis. The European Network for the Study of Adrenal Tumours (ENSAT) stage (hazard ratio [HR] 3.60 [95% confidence interval (CI) 1.25-10.38]; p=0.018), large vessel invasion (HR 5.19 [95% CI 1.75-15.37]; p=0.003), and mitotane use (HR 0.27 [95% CI 0.11-0.70]; p=0.007) were significantly associated with overall survival (OS). There was no single factor independently associated with progression-free survival.

Conclusion: ENSAT stage had a substantial impact on overall survival though there was no difference in OS between patients with stage II and stage III ACC. Large vessel invasion portended poor prognosis and influenced OS significantly. Moreover, mitotane only improved clinical outcomes of patients with stage IV disease.

Keywords: adrenal carcinomas; adrenocortical carcinoma; mitotane; overall survival (OS); progression-free survival (PFS).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Neoplasms* / drug therapy
Adrenal Cortex Neoplasms* / therapy
Adrenocortical Carcinoma* / drug therapy
Adrenocortical Carcinoma* / therapy
Female
Humans
Mitotane
Neoplasm Recurrence, Local / drug therapy
Prognosis

Substances

Mitotane

Grants and funding

This work was supported in part by research grants No. V108C-197, V109C-179, V110C-198, V111D62-002-MY3-1, V112C-183 and V111D62-002-MY3-2 to L-YL from Taipei Veterans General Hospital, Taipei, Taiwan and MOST 111-2314-B-075-040-MY2 to L-YL from National Science and Technology Council, Taiwan.