K. K. Rossfeld1, N. Saunders2, T. Tran13, Q. Duh9, J. Mansour8, S. Maithel2, C. Solorzano10, T. Wang4, J. Glenn4, E. Levine11, S. Weber6, A. Salem6, R. Fields5, G. Poultsides13, T. Pawlik1, J. Phay1, L. A. Shirley1 1Ohio State University,Department Of Surgery,Columbus, OH, USA 2Emory University School Of Medicine,Department Of Surgery,Atlanta, GA, USA 3Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 4Medical College Of Wisconsin,Department Of Surgery,Milwaukee, WI, USA 5Washington University,Department Of Surgery,St. Louis, MO, USA 6University Of Wisconsin,Department Of Surgery,Madison, WI, USA 7University Of California – San Diego,Department Of Surgery,San Diego, CA, USA 8University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA 9University Of California – San Francisco,Department Of Surgery,San Francisco, CA, USA 10Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA 11Wake Forest University School Of Medicine,Department Of Surgery,Winston-Salem, NC, USA 12New York University School Of Medicine,Department Of Surgery,New York, NY, USA 13Stanford University,Department Of Surgery,Palo Alto, CA, USA
Introduction:
Adrenal tumors, including adrenocortical carcinomas (ACC), are often identified incidentally on imaging, being diagnosed as an “incidentaloma”. Little is known regarding the difference in prognosis among patients who have an incidental ACC versus those patients with ACC who present with signs or symptoms.
Methods:
Patients who underwent resection of ACC at one of 13 institutions between January 1993 and December 2014 were identified. ACC tumors were categorized as incidentalomas versus symptomatic adrenal tumors. Patients without data fields needed for the current study were excluded. Data on patient age, gender, race, body mass index (BMI), tumor size, tumor weight, presence of metastases, and margin status were collected and analyzed according to incidental versus non-incidental ACC category. Clinical variables were analyzed using Chi-square, Fisher Exact, or independent T-test as appropriate. Kaplan-Meier curves for overall (OS) and recurrence-free survival (RFS) were analyzed using log-rank testing. Cox regression was utilized to analyze potential differences in OS and RFS among relevant clinical variables.
Results:
Among 232 evaluable patients with ACC, 100 (43.1%) were diagnosed with an incidental ACC while 132 (56.9%) patients presented with symptoms/signs. Clinical and pathological features including age, gender, race, BMI, nodal status, tumor size, tumor weight, and surgical margin status were all comparable among incidental versus non-incidental ACC patients (all p>0.05). However, patients with incidentalomas were more likely to have a T1/T2 tumor (55.8% vs. 33.9%, p<0.01) and were less likely to have metastatic disease at presentation (13.1 % vs. 23.6%, p=0.031). Patients with an incidental ACC had a better median RFS (29.4 months) compared with patients with a non-incidental ACC (12.5 months, p=0.020). The improved RFS among patients with incidental ACC tumors persisted when RFS was stratified by the presence of metastasis (p=0.034), but not by T stage (p= 0.29). Among patients who initially presented with an incidentaloma, those who had tumors that were later noted to be hormonally active on further work-up had a shorter RFS compared with patients with non-functional tumors (8.8 vs. 47.9 months, p=0.002).
Conclusion:
Patients with resected ACC who had tumors that were identified incidentally had an improved RFS compared with patients who presented with symptoms or signs. This difference in RFS was likely related to a lower T-stage on presentation. Patients with incidentalomas that were hormonally active had a shorter RFS than those with non-functional incidentalomas, highlighting potential prognostic importance of evaluating hormonal secretion in asymptomatic patients.
