Background

After radical resection, patients with adrenocortical carcinoma (ACC) frequently experience recurrence and, therefore, effective adjuvant treatment is urgently needed. The aim of the study was to investigate the role of adjuvant platinum-based therapy.

Methods

In this retrospective multicentre cohort study, we identified patients treated with adjuvant platinum-based chemotherapy after radical resection and compared them with patients without adjuvant chemotherapy. Recurrence-free and overall survival (RFS/OS) were investigated in a matched group analysis and by applying a propensity score matching using the full control cohort (n = 268). For both approaches, we accounted for immortal time bias.

Results

Of the 31 patients in the platinum cohort (R0 n = 25, RX n = 4, R1 n = 2; ENSAT Stage II n = 11, III n = 16, IV n = 4, median Ki67 30%, mitotane n = 28), 14 experienced recurrence compared to 29 of 31 matched controls (median RFS after the landmark at 3 months 17.3 vs. 7.3 months; adjusted HR 0.19 (95% CI 0.09–0.42; P < 0.001). Using propensity score matching, the HR for RFS was 0.45 (0.29–0.89, P = 0.021) and for OS 0.25 (0.09–0.69; P = 0.007).

Conclusions

Our study provides the first evidence that adjuvant platinum-based chemotherapy may be associated with prolonged recurrence-free and overall survival in patients with ACC and a very high risk for recurrence.

中文翻译：

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根治性切除的肾上腺皮质癌中以铂为基础的辅助化疗：一项队列研究

背景

根治性切除后，肾上腺皮质癌（ACC）患者经常出现复发，因此迫切需要有效的辅助治疗。该研究的目的是调查基于铂的辅助治疗的作用。

方法

在这项回顾性多中心队列研究中，我们确定了根治性切除术后接受铂类辅助化疗的患者，并将其与未接受辅助化疗的患者进行比较。无复发生存期和总生存期 (RFS/OS) 在匹配组分析中进行了调查，并通过使用完整对照组 ( n  = 268) 应用倾向得分匹配进行了调查。对于这两种方法，我们都考虑了不朽的时间偏差。

结果

在铂类队列的 31 名患者中（R0 n  = 25，RX n  = 4，R1 n  = 2；ENSAT II 期n  = 11，III n  = 16，IV n  = 4，中位 Ki67 30%，米托坦n  = 28 )，与 31 名匹配对照中的 29 名相比，有 14 名出现复发（3 个月标志性标志后的中位 RFS 17.3 对 7.3 个月；调整后的 HR 0.19（95% CI 0.09-0.42；P  < 0.001）。使用倾向评分匹配，HR RFS 为 0.45 (0.29–0.89, P  = 0.021)，OS 为 0.25 (0.09–0.69; P  = 0.007)。

结论

我们的研究提供了第一个证据，表明以铂类为基础的辅助化疗可能与 ACC 患者的无复发生存期和总生存期延长以及复发风险非常高有关。