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Research Article

Cancer Research Frontiers. 2016 Sept; 2(3): 368-379. doi: 10.17980/2016.368

Recurrence and mortality in adulthood adrenocortical tumors: analysis from the Brazilian National Institute of Cancer experience.

Daniel Bulzico1,3*, Paulo Antônio Faria2, Marcela de Paula3, Fernanda Vaisman1, Cencita Pessoa1, Bruno Vilhena4, Rossana Corbo1,5, Mario Vaisman6, Leonardo Vieira Neto3,6.

  1. Endocrine Oncology Unit, Brazilian National Institute of Cancer – INCA, Rio de Janeiro, RJ, Brazil.
  2. Division of Pathology, Brazilian National Institute of Cancer – INCA, Rio de Janeiro, RJ, Brazil.
  3. Endocrinology Section, Federal Hospital of Lagoa, Rio de Janeiro, RJ, Brazil.
  4. Department of Clinical Oncology, Brazilian National Institute of Cancer – INCA, Rio de Janeiro, RJ, Brazil.
  5. Nuclear Medicine Department – Medical School and Clementino Fraga Filho University Hospital, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.
  6. Department of Internal Medicine and Endocrinology Section – Medical School and Clementino Fraga Filho University Hospital, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.

 

*Corresponding author: Daniel Bulzico, MD. Endocrine Oncology Unit, Brazilian National Institute of Cancer – INCA. Praça da Cruz Vermelha, 23, 8o floor. Rio de Janeiro/RJ, Brazil; CEP 20.230-130. Phone/fax: +55-21-3207-1177 ; E-mail: danielbulzico@gmail.com

Citation: Daniel Bulzico, et al. Recurrence and mortality in adulthood adrenocortical tumors: analysis from the Brazilian National Institute of Cancer experience. Cancer Research Frontiers. 2016 Sept; 2(3): 368-379. doi: 10.17980/2016.368

Copyright: @ 2016 Daniel Bulzico, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing Interests: The authors declare no competing financial interests.

Received Sept 28, 2016; Revised Nov 19, 2016; Accepted Dec 3, 2016. Published Dec 13, 2016

 

 Abstract

Introduction: While adrenocortical adenomas (ACA) are usually of indolent course, carcinomas (ACC) are very aggressive, extremely rare and harbor a poor prognosis. This study aimed to describe the experience of a high-complexity cancer center in the management of adrenocortical tumors (ACT) and additionally to identify clinical and pathology prognostic factors of recurrence and death in this population.

Methods: Clinical, pathology, demographic, staging, and therapy data from patients with adulthood ACT treated at the Brazilian National Institute of Cancer between 1997 and 2015 were assessed in this retrospective study. Univariate and bivariate analysis were used to study the association of clinical and pathology characteristics with recurrence and mortality. Recurrence and disease-related mortality were the main outcomes.

Results: Twenty-six patients with adrenocortical carcinoma (ACC) and 22 with adrenocortical adenoma (ACA) were included. The median tumor size was 14 cm and 3.1 cm respectively. Complete resection was achieved in only 13 patients (50%) with ACC. Mitotane was the most common adjuvant/palliative therapy (n=15). Recurrence occurred in six ACC patients, after a median time of 1.7 year. Thirteen (54%) patients with ACC died from the disease. Advanced stage (p<0.001), metastatic disease (p=0.004), incomplete tumor resection (p=0.04), and capsular invasion (p=0.04) were all associated with increased death risk.

Conclusion: Complete tumor resection remains the only potential curable strategy for ACC patients. Therefore, prompt diagnosis of malignant adrenocortical tumors is essential.

Key words: adrenal tumors, surgery, prognosis, cancer staging.

 

 

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