Basile Vittoria, Puglisi Soraya, Altieri Barbara, Canu Letizia, Libè Rossella, Ceccato Filippo, Beuschlein Felix, Quinkler Marcus, Calabrese Anna, Perotti Paola, Berchialla Paola, Dischinger Ulrich, Megerle Felix, Baudin Eric, Bourdeau Isabelle, Lacroix André, Loli Paola, Berruti Alfredo, Kastelan Darko, Haak Harm R, Fassnacht Martin, Terzolo Massimo
Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, 10043 Turin, Italy.
Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, 97080 Würzburg, Germany.
J Pers Med. 2021 Apr 4;11(4):269. doi: 10.3390/jpm11040269.
A relevant issue on the treatment of adrenocortical carcinoma (ACC) concerns the optimal duration of adjuvant mitotane treatment. We tried to address this question, assessing whether a correlation exists between the duration of adjuvant mitotane treatment and recurrence-free survival (RFS) of patients with ACC. We conducted a multicenter retrospective analysis on 154 ACC patients treated for ≥12 months with adjuvant mitotane after radical surgery and who were free of disease at the mitotane stop. During a median follow-up of 38 months, 19 patients (12.3%) experienced recurrence. We calculated the RFS after mitotane (RFSAM), from the landmark time-point of mitotane discontinuation, to overcome immortal time bias. We found a wide variability in the duration of adjuvant mitotane treatment among different centers and also among patients cared for at the same center, reflecting heterogeneous practice. We did not find any survival advantage in patients treated for longer than 24 months. Moreover, the relationship between treatment duration and the frequency of ACC recurrence was not linear after stratifying our patients in tertiles of length of adjuvant treatment. In conclusion, the present findings do not support the concept that extending adjuvant mitotane treatment over two years is beneficial for ACC patients with low to moderate risk of recurrence.
肾上腺皮质癌（ACC）治疗中的一个相关问题涉及辅助米托坦治疗的最佳时长。我们试图解决这个问题，评估辅助米托坦治疗时长与ACC患者无复发生存期（RFS）之间是否存在关联。我们对154例ACC患者进行了多中心回顾性分析，这些患者在根治性手术后接受了≥12个月的辅助米托坦治疗，且在米托坦停药时无疾病。在中位随访38个月期间，19例患者（12.3%）出现复发。为克服不朽时间偏倚，我们计算了从米托坦停药这个标志性时间点开始的米托坦治疗后无复发生存期（RFSAM）。我们发现不同中心之间以及同一中心治疗的患者之间，辅助米托坦治疗时长存在很大差异，这反映了治疗实践的异质性。我们未发现接受超过24个月治疗的患者有任何生存优势。此外，在将我们的患者按辅助治疗时长三分位数分层后，治疗时长与ACC复发频率之间的关系并非呈线性。总之，目前的研究结果不支持将辅助米托坦治疗延长至两年以上对复发风险低至中度的ACC患者有益这一观点。
