Adrenocortical carcinoma: prognostic factors on local recurrence and results of reoperations. A retrospective study of 22 patients.

Adrenocortical carcinoma: prognostic factors on local recurrence and results of reoperations. A retrospective study of 22 patients. Study alms: The aim of this retrospective study was to identify prognostic factors on local recurrence in patients with adrenocortical carcinoma and to assess the effect of reoperations. Methods: From 1985 to 2001, 22 patients were operated for adrenocortical carcinoma. We evaluated the correlation between actuarial survival without local recurrence and tumor staging, Weiss criteria, mitotic index, extensive resection and Op'DDD therapy by univariate analysis. Then we evaluated the effect of reoperations on survival. Results: Local recurrence was observed in 7 patients and the 5-years actuarial survival without local recurrence was 50%. Tumor stage (I et II versus III et IV), Weiss criteria (less than or equal to 6 criteria versus > 6) and mitotic index (less than or equal to 20 mitoses/50 HPF versus > 20) affected survival without local recurrence. Extensive resection could reduce local recurrence rate. Op'DDD therapy was ineffective in prolonging survival without local recurrence. Four patients underwent repeat resections: 2 patients were still alive with disease free, 54 and 8 months after reoperations and 2 patients died, 19 and 25 months after reoperations. Three patients did not have repeat resection. They rapidly died within 8 months. Conclusion: Pathologic features (tumor staging and mitotic index) affected local recurrence prognostic. But extensive resection to adjacent organs could facilitate complete resection tumor and reduce the local recurrence rate. Complete repeat resection of local recurrence can improve survival. The disabling effects of Op'DDD were important and its efficacy was not clear. (C) 2002 Editions scientifiques et medicales Elsevier SAS.