01.12.2017 | Research article | Ausgabe 1/2017 Open Access

Outcome after resection of Adrenocortical Carcinoma liver metastases: a retrospective study
- Zeitschrift:
- BMC Cancer > Ausgabe 1/2017
Background
Methods
Data source
Patient selection
Statistical analysis
Results
Patient characteristics
overall
|
Liver resection
|
no Liver resection
|
p-value
|
||||
---|---|---|---|---|---|---|---|
n
|
(%)
|
n
|
(%)
|
n
|
(%)
|
||
Patiens
|
|||||||
overall
|
77
|
43
|
34
|
||||
female
|
56
|
(72.7%)
|
30
|
(69.8%)
|
26
|
(76.5%)
|
0.512
|
Mean age at first diagnosis [y]
|
49.5
|
45.5
|
54.5
|
0.016
|
|||
Mean age at diagnosis of liver metastases [y]
|
49.8
|
46.0
|
54.7
|
0.017
|
|||
Primary tumour
|
|||||||
Localisation
|
|||||||
right gland
|
38
|
(49.4%)
|
26
|
(60.5%)
|
12
|
(35.3%)
|
0.061
|
left gland
|
38
|
(49.4%)
|
17
|
(39.5%)
|
21
|
(61.8%)
|
|
both glands
|
1
|
(1.3%)
|
0
|
(0.0%)
|
1
|
(2.9%)
|
|
Diameter
|
|||||||
> 10 cm
|
52
|
(67.5%)
|
24
|
(55.8%)
|
28
|
(82.4%)
|
< 0.001
|
≦ 10 cm
|
17
|
(22.1%)
|
16
|
(37.2%)
|
1
|
(2.9%)
|
|
unknown
|
5
|
(6.5%)
|
0
|
(0.0%)
|
5
|
(14.7%)
|
|
Hormon status at presentation
|
|||||||
functional
|
38
|
(49.4%)
|
21
|
(48.8%)
|
17
|
(50.0%)
|
< 0.001
|
non-functional
|
21
|
(27.3%)
|
15
|
(34.9%)
|
6
|
(17.6%)
|
|
unknown
|
11
|
(14.3%)
|
0
|
(0.0%)
|
11
|
(32.4%)
|
|
Liver metastases
|
|||||||
Simultaneous liver metastases
|
33
|
(42.9%)
|
13
|
(30.2%)
|
20
|
(58.8%)
|
0.012
|
Secondary liver metastases
|
44
|
(57.1%)
|
30
|
(69.8%)
|
14
|
(41.2%)
|
|
Time between first diagnosis and liver metastases [m]
|
43.9
|
60.5
|
8.4
|
0.002
|
|||
Number
|
|||||||
1
|
35
|
(45.5%)
|
26
|
(60.5%)
|
9
|
(26.5%)
|
< 0.001
|
2-5
|
12
|
(15.6%)
|
7
|
(16.3%)
|
5
|
(14.7%)
|
|
> 5
|
20
|
(26.0%)
|
0
|
(0.0%)
|
20
|
(58.8%)
|
|
unknown
|
10
|
(13.0%)
|
10
|
(23.3%)
|
0
|
(0.0%)
|
|
Systemic therapies after diagnosis of liver metastases
|
|||||||
Mitotane
|
43
|
(55.8%)
|
21
|
(48.8%)
|
22
|
(64.7%)
|
0.164
|
Chemotherapy
|
24
|
(31.2%)
|
8
|
(18.6%)
|
16
|
(47.1%)
|
0.007
|
Liver resection for ACC metastases
overall
|
secondary resection
|
simultaneous resection
|
||
---|---|---|---|---|
Extend of first liver resection
|
||||
1 segment
|
15 (34.9%)
|
9
|
(30.0%)
|
6 (46.2%)
|
2 segments
|
13 (30.2%)
|
8
|
(26.7%)
|
5 (38.5%)
|
mutltiple segments
|
1 (2.3%)
|
1
|
(3.3%)
|
0 (0.0%)
|
hemihepatectomy
|
7 (16.3%)
|
6
|
(20.0%)
|
1 (7.7%)
|
extended hemihepatectomy
|
3 (7.0%)
|
2
|
(6.7%)
|
1 (7.7%)
|
atypical resection
|
2 (4.7%)
|
2
|
(6.7%)
|
0 (0.0%)
|
unknown
|
2 (4.7%)
|
2
|
(6.7%)
|
0 (0.0%)
|
Resection Status of first liver resection
|
||||
R0
|
30 (69.8%)
|
23
|
(76.7%)
|
7 (53.8%)
|
R1
|
8 (18.6%)
|
5
|
(16.7%)
|
3 (23.1%)
|
Rx
|
5 (11.6%)
|
2
|
(6.7%)
|
3 (23.1%)
|
Systemic Therapies after first liver Resection
a
|
||||
Mitotane
|
21 (48.8%)
|
17
|
(56.7%)
|
4 (30.8%)
|
Chemotherapy
|
8 (18.6%)
|
3
|
(10.0%)
|
5 (38.5%)
|
Overall and disease free survival
Predictive factors
Univariate analysis
|
Multivariate analysis
|
|||||||
---|---|---|---|---|---|---|---|---|
n
|
median survival [mo]
|
HR
|
95% CI
|
p-value
|
HR
|
95% CI
|
p-value
|
|
Sex
|
||||||||
female
|
30
|
76.1
|
1
|
|||||
male
|
13
|
58.9
|
1.066
|
0.444 - 2.563
|
0.886
|
|||
Age at first liver resection (yr)
|
||||||||
≤ 50
|
13
|
93.3
|
1
|
|||||
> 50
|
30
|
41.6
|
2.225
|
0.830 - 5.964
|
0.112
|
|||
Occurence of liver metastases
|
||||||||
secondary
|
30
|
89.3
|
1
|
|||||
simultaneous
|
13
|
23.3
|
1.485
|
0.673 - 3.278
|
0.327
|
|||
Major liver resection
|
||||||||
no
|
30
|
57.8
|
1
|
|||||
yes
|
11
|
93.3
|
0.580
|
0.226 - 1.488
|
0.257
|
|||
Number of liver metastases
|
||||||||
1
|
26
|
89.3
|
1
|
1
|
||||
> 1
|
7
|
35.5
|
2.620
|
1.008 - 6.808
|
0.048
|
2.455
|
0.888 - 6.786
|
0.083
|
Pathologic margin
|
||||||||
R0
|
30
|
58.9
|
||||||
R1
|
8
|
93.3
|
1.037
|
0.372 - 2.889
|
0.945
|
|||
Rx
|
5
|
92.3
|
1.127
|
0.401 - 3.167
|
0.821
|
|||
Side of primary tumour
|
||||||||
right
|
26
|
76.1
|
1
|
|||||
left
|
17
|
89.3
|
0.772
|
0.349 - 1.707
|
0.522
|
|||
Size of primary tumour (cm)
|
||||||||
≤ 10
|
16
|
92.3
|
1
|
|||||
> 10
|
24
|
41.6
|
2.059
|
0.855 - 4.954
|
0.107
|
|||
Secreting primary tumour
|
||||||||
no
|
15
|
90.3
|
1
|
|||||
yes
|
21
|
42.6
|
1.624
|
0.665 - 3.962
|
0.287
|
|||
Chemotherapy after liver resection
|
||||||||
no
|
35
|
90.3
|
1
|
1
|
||||
yes
|
8
|
17.3
|
12.176
|
3.765 - 39.373
|
< 0.001
|
3.453
|
0.774 - 15.410
|
0.104
|
Mitotane after liver resection
|
||||||||
no
|
22
|
90.3
|
1
|
|||||
yes
|
21
|
57.8
|
1.010
|
0.446 - 2.288
|
0.981
|
|||
Time to liver metastases [mo]
|
||||||||
> 12
|
25
|
90.3
|
1
|
1
|
||||
≤ 12
|
18
|
23.3
|
1.983
|
0.916 - 4.292
|
0.082
|
2.876
|
0.770 - 10.7431
|
0.116
|
Univariate analysis
|
Multivariate analysis
|
|||||||
---|---|---|---|---|---|---|---|---|
n
|
median survival [mo]
|
HR
|
95% CI
|
p-value
|
HR
|
95% CI
|
p-value
|
|
Sex
|
||||||||
female
|
30
|
10.2
|
1
|
|||||
male
|
13
|
7.1
|
1.062
|
0.528 - 2.136
|
0.866
|
|||
Age at first liver resection (yr)
|
||||||||
≤ 50
|
13
|
35.5
|
1
|
|||||
> 50
|
30
|
7.1
|
1.552
|
0.759 - 3.173
|
0.229
|
|||
Occurence of liver metastases
|
||||||||
secondary
|
30
|
9.1
|
1
|
|||||
simultaneous
|
13
|
7.1
|
1.309
|
0.640 - 2.677
|
0.461
|
|||
Major liver resection
|
||||||||
no
|
30
|
7.1
|
1
|
|||||
yes
|
11
|
31.4
|
0.558
|
0.256
|
1.216
|
0.142
|
||
Number of liver metastases
|
||||||||
1
|
26
|
11.2
|
1
|
1
|
||||
> 1
|
7
|
4.1
|
2.490
|
1.028 - 6.034
|
0.043
|
3.747
|
1.292 - 10.865
|
0.015
|
Pathologic margin
|
||||||||
R0
|
30
|
10.2
|
1
|
|||||
R1
|
8
|
3.1
|
1.859
|
0.827 - 4.175
|
0.133
|
|||
Rx
|
5
|
73.1
|
0.809
|
0.276 - 2.377
|
0.700
|
|||
Side of primary tumour
|
||||||||
right
|
26
|
7.1
|
1
|
|||||
left
|
17
|
15.2
|
0.710
|
0.367 - 1.374
|
0.309
|
|||
Size of primary tumour (cm)
|
||||||||
≤ 10
|
16
|
18.2
|
1
|
1
|
||||
> 10
|
24
|
7.1
|
2.034
|
0.985 - 4.198
|
0.055
|
2.764
|
1.062 - 7.192
|
0.037
|
Secreting primary tumour
|
||||||||
no
|
15
|
13.2
|
1
|
|||||
yes
|
21
|
9.1
|
1.008
|
0.490 - 2.071
|
0.983
|
|||
Chemotherapy after liver resection
|
||||||||
no
|
35
|
15.2
|
1
|
1
|
||||
yes
|
8
|
3.1
|
2.844
|
1.193 - 6.777
|
0.018
|
2.568
|
0.936 - 7.043
|
0.067
|
Mitotane after liver resection
|
||||||||
no
|
22
|
7.1
|
1
|
|||||
yes
|
21
|
10.2
|
0.994
|
0.517 - 1.912
|
0.985
|
|||
Time to liver metastases [mo]
|
||||||||
> 12
|
25
|
18.3
|
1
|
|||||
≤ 12
|
18
|
6.1
|
1.754
|
0.895 - 3.436
|
0.102
|
Recurrence after liver resection
overall
|
secondary resection
|
simultaneous resection
|
|
---|---|---|---|
Recurrence after first liver resection
|
38 (88.4%)
|
27 (90.0%)
|
11 (84.6%)
|
Median Overall Survival [mo]
|
57.8
|
58.9
|
19.3
|
Median disease-free survival [mo]
|
11.1
|
10.2
|
11.2
|
Localisation of Recurrene
|
|||
Liver
|
22 (57.9%)
|
15 (55.6%)
|
7 (63.6%)
|
Abdomen
|
7 (18.4%)
|
6 (22.2%)
|
1 (9.1%)
|
Lung
|
11 (28.9%)
|
7 (25.9%)
|
4 (36.4%)
|
Bone
|
3 (7.9%)
|
2 (7.4%)
|
1 (9.1%)
|
multiple Localisations
|
4 (10.5%)
|
2 (7.4%)
|
2 (18.2%)
|