BACKGROUND We sought to define the impact of cortisol-secreting status on outcomes after surgical resection of adrenocortical carcinoma (ACC). developed a recurrence. On multivariable analysis after adjusting for patient and disease-related factors cortisol secretion independently predicted shorter recurrence-free survival (Hazard ratio = 2.05 95 confidence interval = 1.16 to 3.60; = .01). CONCLUSIONS Cortisol secretion was associated with an increased risk of postoperative morbidity. Recurrence remains high among patients with ACC after surgery; cortisol secretion was independently associated Clindamycin palmitate HCl with a shorter recurrence-free survival. Tailoring postoperative surveillance of ACC patients based on their cortisol secreting status may be important. < .05) were entered into the multivariable regression models. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier methods. Univariable and multivariable Cox proportional hazards models were built to determine factors predictive of risk of recurrence or death. For multivariable Cox proportional hazards models variables with missing data were subjected to multiple imputation and all variables of clinical importance were included. Comparisons of survival between groups were made using the log-rank test. All analyses were performed with STATA version 12.0 (StataCorp College Station TX) and < .05 (2 tailed) was considered statistically significant. Results Clindamycin palmitate HCl Demographic and clinicopathologic features A total of 234 patients were identified. Table 1 shows the baseline characteristics of the entire cohort stratified by functional status and cortisol-secreting status. The median patient age was 52 years (IQR 44 to 63); most of the patients were female (= 144 61.5%) and Caucasian (= 185 81.1%). The median tumor size was 11.5 cm (IQR 8.0 to 15.0 Clindamycin palmitate HCl cm). At the time of surgery most of the patients underwent an open abdominal adrenalectomy (= 152 67 The remaining patients underwent either an open thoraco-abdominal (= 34 15 or a minimally invasive surgery (= 41 18.1%). On final histopathology an R0 resection was achieved in most patients (= 143 68.4%). Most of the patients had T3/4 stage disease (= 113 52.8%). Most of the tumors (20.1%) had a mitotic rate of greater than 10 mitoses/50 HPF whereas 14.5% had a mitotic rate of 6 to 10 mitoses/50 HPF and 10.7% had a mitotic rate of less than 5 mitoses/50 HPF. Overall 36 patients (16.7%) received postoperative systemic chemotherapy whereas 78 patients received adjuvant mitotane (42.2%). Preoperative chemotherapy was administered only to 4 patients (1.8%). Regarding the secretory status 53 patients had cortisol- 29 had estrogen/androgen- and 13 patients had mineralocorticoid-secreting tumors. Table 1 Baseline characteristics of patients undergoing surgery for adrenocortical carcinoma The distribution of cortisol excess according to clinical symptoms demonstrated that patients with cortisol-secreting tumors were more likely to present with leg edema vs patients with nonfunctional tumors (cortisol-secreting 41.2% vs nonfunctional 9.6%; < .001). Conversely patients with cortisol-secreting tumors were less likely to present with abdominal pain vs patients with nonfunctional tumors (cortisol secreting 35.3% vs nonfunctional 53.4%; < .05). The size of ACCs in patients with cortisol-secreting tumors was smaller compared with patients who had other functional tumors (cortisol secreting 11.2 cm vs other functional 13.2 cm; < Clindamycin palmitate HCl .05). On histopathology patients with cortisol-secreting tumors were more likely to have metastatic disease (cortisol secreting Clindamycin palmitate HCl 34 vs nonfunctional 10.8%; < .001) and to undergo an R1 resection compared with patients who had nonfunctional tumors (cortisol secreting 41.7% vs nonfunctional 19.8%; < .05). Patients with cortisol-secreting tumors were also Clindamycin palmitate HCl more likely to receive postoperative Rabbit Polyclonal to GFM2. mitotane vs patients who had nonfunctional tumors (cortisol secreting 62.2% vs nonfunctional 31.1%; < .001). Short-term clinical outcomes A total of 66 patients (37.5%) experienced a postoperative complication (Table 1). In examining the entire cohort 45 patients (68.2%) had a minor complication and 21 (31.8%) had a major complication. Patients with cortisol-secreting tumors had a more pronounced risk of postoperative complications vs patients with nonfunctional tumors (cortisol secreting 51.2% vs nonfunctional 32 < .05). Postoperative adrenal insufficiency was more common in patients with cortisol-secreting tumors compared with patients who had either other functional or nonfunctional tumors (cortisol secreting 50 vs.