The effect of hormonal secretion on survival in adrenocortical carcinoma: A multi-center study

Alaa Sada, Trenton R. Foster, Ruaa Al-Ward, Sahar Sawani, HElaine E. Charchar, Reza Pishdad, Anat Ben-Shlomo, Benzon M. Dy, Melanie L. Lyden, Emily Bergsland, Sina Jasim, Nitya Raj, Jessica B. Shank, Oksana Hamidi, Amir H. Hamrahian, José L. Chambô, Victor Srougi, Maria CBV Fragoso, Paul H. Graham, Mouhammed Amir HabraIrina Bancos, Travis J. McKenzie

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Current evidence suggests that cortisol secreting adrenocortical carcinoma has worse prognosis compared to non-secreting adrenocortical carcinoma. However, the effect of other secretory subtypes is unknown. Methods: This multicenter study within the American-Australian-Asian Adrenal Alliance included adults with adrenocortical carcinoma (1997–2020). We compared overall survival and disease-free survival among cortisol secreting, mixed cortisol/androgen secreting, androgen secreting, and non-secreting adrenocortical carcinoma. Results: Of the 807 patients (mean age 50), 719 included in the secretory subtype analysis: 24.5% were cortisol secreting, 13% androgen secreting, 28% mixed cortisol/androgen, 32.5% non-secreting, and 2% were mineralocorticoid secreting. Median overall survival and disease-free survival for the entire cohort were 60 and 9 months, respectively. Median overall survival was 36 months for cortisol, 30 for mixed, 60 for androgen secreting, and 115 for non-secreting adrenocortical carcinoma, P <.01. Median disease-free survival was 7 months for cortisol, 8 for mixed, 10 for androgen, and 12 for non-secreting adrenocortical carcinoma, P =.06. On multivariable analysis of age, sex, Ki67%, secretory subtype, stage, resection, and adjuvant therapy, predictors of worse overall survival were older age, higher Ki67%, stage IV, mixed secreting, R1, and no adjuvant therapy, P <.05. On subgroup analysis of R0 resection, predictors of worse overall survival included older age and higher Ki67%. Ki67% ≥40, stage III and cortisol secretion were associated with worse disease-free survival. Conclusion: Mixed cortisol/androgen secreting adrenocortical carcinoma was associated with worse overall survival, while cortisol or androgen secreting alone were not. Notably, among patients after R0 resection, secretory subtype did not affect overall survival. Cortisol secreting adrenocortical carcinoma demonstrated worse disease-free survival. Ki67% remained a strong predictor of worse overall survival and disease-free survival independent of stage.

Original languageEnglish
Pages (from-to)80-89
Number of pages10
JournalSurgery (United States)
Volume175
Issue number1
DOIs
StatePublished - Jan 2024

Fingerprint

Dive into the research topics of 'The effect of hormonal secretion on survival in adrenocortical carcinoma: A multi-center study'. Together they form a unique fingerprint.

Cite this