Tizianel Irene, Caccese Mario, Torresan Francesca, Lombardi Giuseppe, Evangelista Laura, Crimì Filippo, Sepulcri Matteo, Iacobone Maurizio, Padovan Marta, Galuppini Francesca, Zagonel Vittorina, Scaroni Carla, Ceccato Filippo
Department of Medicine DIMED, University of Padova, 35128 Padua, Italy.
Endocrine Disease Unit, University-Hospital of Padova, 35128 Padua, Italy.
Cancers (Basel). 2022 Aug 12;14(16):3904. doi: 10.3390/cancers14163904.
We aimed to evaluate the role of adrenal multidisciplinary team evaluation (MTE) in affecting the overall survival (OS) and progression-free survival (PFS) in patients with adrenocortical carcinoma (ACC). We included in a retrospective monocentric study 47 patients with ACC. We divided our cohort into group 1 (without adrenal-MTE discussion, ACC diagnosis from 2004 to 2012, n = 14) and group 2 (diagnosis and beginning of treatments after 2013, all discussed in the adrenal MTE, n = 33). OS was defined by the survival between the first and the last visit, while PFS as the time from the first visit to the progression of the disease. Kaplan−Meier curves were used to compare OS and PFS between Group 1 and Group 2. Group 1stages III−IV (n = 10) presented a shorter median OS than Group 2stages III−IV (25 patients, 4 vs. 31 months, p = 0.023). Likewise, the median PFS was lower in Group 1 as compared to Group 2 (2.9 vs. 17.2 months, p < 0.001). The gain in PFS (6 months) was also confirmed in stage III-IV patients (2.9 vs. 8.7 months, respectively, for Group 1 and Group 2, p = 0.02). Group 1 presented a median PFS of 4 months, while the median PFS of Group 2 was 14.7 months (p = 0.128). In conclusion, we found a significant gain in terms of survival in patients after the MTE discussion in 2013. Therefore, ACC patients should be referred to a tertiary center, ideally from the time of diagnosis, to promptly apply all available treatments, according to the single patient’s clinical history and based on multidisciplinary management.
我们旨在评估肾上腺多学科团队评估（MTE）对肾上腺皮质癌（ACC）患者总生存期（OS）和无进展生存期（PFS）的影响。我们纳入了一项回顾性单中心研究，共47例ACC患者。我们将队列分为第1组（未进行肾上腺MTE讨论，2004年至2012年诊断为ACC，n = 14）和第2组（2013年后诊断并开始治疗，所有病例均在肾上腺MTE中进行了讨论，n = 33）。OS定义为首次就诊与末次就诊之间的生存期，而PFS为从首次就诊到疾病进展的时间。采用Kaplan-Meier曲线比较第1组和第2组的OS和PFS。第1组III-IV期（n = 10）患者的中位OS短于第2组III-IV期患者（25例，4个月对31个月，p = 0.023）。同样，第1组的中位PFS低于第2组（2.9个月对17.2个月，p < 0.001）。III-IV期患者的PFS获益（6个月）也得到证实（第1组和第2组分别为2.9个月对8.7个月，p = 0.02）。第1组的中位PFS为4个月，而第2组的中位PFS为14.7个月（p = 0.128）。总之，我们发现2013年MTE讨论后患者的生存期有显著获益。因此，ACC患者应转诊至三级中心，最好从诊断时起，根据患者的临床病史并基于多学科管理迅速应用所有可用治疗方法。
