Tsuboi Ichiro, Kardoust Parizi Mehdi, Matsukawa Akihiro, Mancon Stefano, Miszczyk Marcin, Schulz Robert J, Fazekas Tamás, Cadenar Anna, Laukhtina Ekaterina, Kawada Tatsushi, Katayama Satoshi, Iwata Takehiro, Bekku Kensuke, Wada Koichiro, Remzi Mesut, Karakiewicz Pierre I, Araki Motoo, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Urol Oncol. 2025 May;43(5):297-306. doi: 10.1016/j.urolonc.2024.09.014. Epub 2024 Oct 7.
Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with a high recurrence rate after surgical therapy with curative intent. Adjuvant radiotherapy (RT) and mitotane therapy have been proposed as options following the adrenalectomy. However, the efficacy of adjuvant RT or mitotane therapy remains controversial. We aimed to evaluate the efficacy of adjuvant therapy in patients who underwent adrenalectomy for localised ACC. The PubMed, Scopus, and Web of Science databases were queried on March 2024 for studies evaluating adjuvant therapies in patients treated with surgery for localized ACC (PROSPERO: CRD42024512849). The endpoints of interest were overall survival (OS) and recurrence-free survival (RFS). Hazard ratios (HR) with 95% confidence intervals (95%CI) were pooled in a random-effects model meta-analysis. One randomized controlled trial (n = 91) and eleven retrospective studies (n = 4,515) were included. Adjuvant mitotane therapy was associated with improved RFS (HR: 0.63, 95%CI: 0.44-0.92, p = 0.016), while adjuvant RT did not reach conventional levels of statistical significance (HR:0.79, 95%CI:0.58-1.06, p = 0.11). Conversely, Adjuvant RT was associated with improved OS (HR:0.69, 95%CI:0.58-0.83, p<0.001), whereas adjuvant mitotane did not (HR: 0.76, 95%CI: 0.57-1.02, p = 0.07). In the subgroup analyses, adjuvant mitotane was associated with better OS (HR:0.46, 95%CI: 0.30-0.69, p < 0.001) and RFS (HR:0.56, 95%CI: 0.32-0.98, p = 0.04) in patients with negative surgical margin. Both adjuvant RT and mitotane were found to be associated with improved oncologic outcomes in patients treated with adrenalectomy for localised ACC. While adjuvant RT significantly improved OS in general population, mitotane appears as an especially promising treatment option in patients with negative surgical margin. These data can support the shared decision-making process, better understanding of the risks, benefits, and effectiveness of these therapies is still needed to guide tailored management of each individual patient.
肾上腺皮质癌（ACC）是一种罕见且侵袭性强的恶性肿瘤，根治性手术治疗后复发率很高。肾上腺切除术后，辅助放疗（RT）和米托坦治疗被提议作为治疗选择。然而，辅助放疗或米托坦治疗的疗效仍存在争议。我们旨在评估接受肾上腺切除术治疗局限性ACC患者的辅助治疗疗效。2024年3月，我们在PubMed、Scopus和Web of Science数据库中查询了评估局限性ACC手术治疗患者辅助治疗的研究（PROSPERO：CRD42024512849）。感兴趣的终点是总生存期（OS）和无复发生存期（RFS）。在随机效应模型的荟萃分析中汇总了具有95%置信区间（95%CI）的风险比（HR）。纳入了一项随机对照试验（n = 91）和十一项回顾性研究（n = 4,515）。辅助米托坦治疗与改善RFS相关（HR：0.63，95%CI：0.44 - 0.92，p = 0.016），而辅助放疗未达到传统统计学意义水平（HR：0.79，95%CI：0.58 - 1.06，p = 0.11）。相反，辅助放疗与改善OS相关（HR：0.69，95%CI：0.58 - 0.83，p<0.001），而辅助米托坦治疗则未显示出这种相关性（HR：0.76，95%CI：0.57 - 1.02，p = 0.07）。在亚组分析中，手术切缘阴性的患者接受辅助米托坦治疗后OS（HR：0.46，95%CI：0.30 - 0.69，p < 0.001）和RFS（HR：0.56，95%CI：0.32 - 0.98，p = 0.04）均得到改善。对于接受肾上腺切除术治疗局限性ACC的患者，辅助放疗和米托坦治疗均与改善肿瘤学结局相关。虽然辅助放疗在总体人群中显著改善了OS，但米托坦似乎是手术切缘阴性患者特别有前景的治疗选择。这些数据可以支持共同决策过程，但仍需要更好地了解这些治疗的风险、益处和有效性，以指导对每个患者的个体化管理。
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