Cytoreductive surgery prolongs survival in metastatic adrenocortical carcinoma

Patients with metastatic adrenocortical carcinoma (ACC) derive benefit from cytoreductive surgery of the primary tumour by improving survival, reveals a recent study.

A team of investigators analysed the impact of cytoreductive surgery of the primary tumour in metastatic ACC patients (aged ≥18 years at initial presentation) in this multicentric, retrospective paired cohort study. They compared the overall survival (OS) in participants treated either with cytoreductive surgery (CR group) or without surgery (no-CR group) between 1 January 1995 and 31 May 2019.

Data were obtained from nine referral centres in the American-Australian-Asian Adrenal Alliance collaborative research group. The investigators conducted a propensity score match using age and the number of organs with metastasis (≤2 or >2). The main outcome, OS, was determined from the date of diagnosis until death or until last follow-up for living patients.

A total of 339 patients were identified, of whom 239 were paired and included (128 in the CR group and 111 in the no-CR group). Mean follow-up was 67 months.

The risk of mortality was higher among patients in the no-CR group than those in the CR group (hazard ratio [HR], 3.18, 95 percent confidence interval [CI], 2.34‒4.32). The following factors independently predicted survival: age (HR, 1.02, 95 percent CI, 1.00‒1.03), hormone excess (HR, 2.56, 95 percent CI, 1.66‒3.92), and local metastasis therapy (HR, 0.41, 95 percent CI, 0.47‒0.65).