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3. A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the US Adrenocortical Carcinoma Study Group

Author

Poorman, Caroline E, Ethun, Cecilia G, Postlewait, Lauren M, Tran, Thuy B, Prescott, Jason D, Pawlik, Timothy M, Wang, Tracy S, Glenn, Jason, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solórzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Staley, Charles A, Poultsides, George A, and Maithel, Shishir K

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Adrenal Cortex Neoplasms, Adrenalectomy, Adrenocortical Carcinoma, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Retrospective Studies, Risk Factors, Survival Rate, Treatment Outcome, Tumor Burden, United States, Oncology and Carcinogenesis, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

BACKGROUND:The 7th AJCC T-stage system for adrenocortical carcinoma (ACC), based on size and extra-adrenal invasion, does not adequately stratify patients by survival. Lymphovascular invasion (LVI) is a known poor prognostic factor. We propose a novel T-stage system that incorporates LVI to better risk-stratify patients undergoing resection for ACC. METHOD:Patients undergoing curative-intent resections for ACC from 1993 to 2014 at 13 institutions comprising the US ACC Group were included. Primary outcome was disease-specific survival (DSS). RESULTS:Of the 265 patients with ACC, 149 were included for analysis. The current T-stage system failed to differentiate patients with T2 versus T3 disease (p = 0.10). Presence of LVI was associated with worse DSS versus no LVI (36 mo vs. 168 mo; p = 0.001). After accounting for the individual components of the current T-stage system (size, extra-adrenal invasion), LVI remained a poor prognostic factor on multivariable analysis (hazard ratio 2.14, 95% confidence interval 1.05-4.38, p = 0.04). LVI positivity further stratified patients with T2 and T3 disease (T2: 37 mo vs. median not reached; T3: 36 mo vs. 96 mo; p = 0.03) but did not influence survival in patients with T1 or T4 disease. By incorporating LVI, a new T-stage classification system was created: [T1: ≤ 5 cm, (-)local invasion, (+/-)LVI; T2: > 5 cm, (-)local invasion, (-)LVI OR any size, (+)local invasion, (-)LVI; T3: > 5 cm, (-)local invasion, (+)LVI OR any size, (+)local invasion, (+)LVI; T4: any size, (+)adjacent organ invasion, (+/-)LVI]. Each progressive new T-stage group was associated with worse median DSS (T1: 167 mo; T2: 96 mo; T3: 37 mo; T4: 15 mo; p

Published
2018

6. CONTRIBUTORS

Author

Ahmadi, Sara, primary, Akula, Monika S., additional, Alexander, Erik K., additional, Angell, Trevor E., additional, Anderson, Maureen McCartney, additional, Bilezikian, John P., additional, Bornstein, Stefan Richard, additional, Calissendorff, Jan, additional, Campbell, Stuart, additional, Chukir, Tariq, additional, Corrigan, Tara, additional, Falhammar, Henrik, additional, Farooki, Azeez, additional, Flippo, Chelsi, additional, Frasier, Lane L., additional, Gemma, Vincent, additional, Girotra, Monica, additional, Goel, Ansha, additional, Goodier, Christopher G., additional, Guzman, Heidi, additional, Ishii, Makoto, additional, Ito, Yasuhiro, additional, Kazim, Michael, additional, Keating, Jane J., additional, Kotwal, Anupam, additional, Krasnova, Svetlana L., additional, Lam, David W., additional, Lechner, Melissa G., additional, Loftley, Aundrea Eason, additional, Lubitz, Sara E., additional, Mandel, Louis, additional, Masuoka, Hiroo, additional, Mestman, Jorge H., additional, Miyauchi, Akira, additional, Nguyen, Caroline T., additional, Ong, Raquel Kristin Sanchez, additional, Owen, Randall P., additional, Pommier, Rodney F., additional, Prescott, Jason D., additional, Punati, Ramya, additional, Romero-Velez, Gustavo, additional, Schneider, Arthur B., additional, Seitz, Alison P., additional, Shifrin, Alexander L., additional, Shiroff, Adam Michael, additional, Stan, Marius N., additional, Stratakis, Constantine A., additional, Tatsi, Christina, additional, Toft, Daniel J., additional, Topilow, Arthur, additional, Tran, Ann Q., additional, Verbalis, Joseph G., additional, Wartofsky, Leonard, additional, Wonn, Sarah M., additional, Ylli, Dorina, additional, and Young, William F., additional

Published
2022
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7. Blood Transfusion and Survival for Resected Adrenocortical Carcinoma: A Study from the United States Adrenocortical Carcinoma Group

Author

Poorman, Caroline E, Postlewait, Lauren M, Ethun, Cecilia G, Tran, Thuy B, Prescott, Jason D, Pawlik, Timothy M, Wang, Tracy S, Glenn, Jason, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Staley, Charles A, Poultsides, George A, and Maithel, Shishir K

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Clinical Trials and Supportive Activities, Basic Behavioral and Social Science, Digestive Diseases, Cancer, Rare Diseases, Clinical Research, Behavioral and Social Science, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Adrenal Cortex Neoplasms, Adrenocortical Carcinoma, Blood Transfusion, Female, Humans, Male, Middle Aged, Prognosis, Proportional Hazards Models, Retrospective Studies, Survival Rate, United States, Surgery, Clinical sciences
Abstract

Perioperative blood transfusion is associated with decreased survival in pancreatic, gastric, and liver cancer. The effect of transfusion in adrenocortical carcinoma (ACC) has not been studied. Patients with available transfusion data undergoing curative-intent resection of ACC from 1993 to 2014 at 13 institutions comprising the United States Adrenocortical Carcinoma Group were included. Factors associated with blood transfusion were determined. Primary and secondary end points were recurrence-free survival (RFS) and overall survival (OS), respectively. Out of 265 patients, 149 were included for analysis. Out of these, 57 patients (38.3%) received perioperative transfusions. Compared to nontransfused patients, transfused patients more commonly had stage 4 disease (46% vs 24%, P = 0.01), larger tumors (15.8 vs 10.2 cm, P < 0.001), inferior vena cava involvement (24.6% vs 5.4%, P = 0.002), additional organ resection (78.9% vs 36.3%, P < 0.001), and major complications (29% vs 2%, P < 0.001). Transfusion was associated with decreased RFS (8.9 vs 24.7 months, P = 0.006) and OS (22.8 vs 91.0 months, P < 0.001). On univariate Cox regression, transfusion, stage IV, hormonal hypersecretion, and adjuvant therapy were associated with decreased RFS. On multivariable analysis, only transfusion [hazard ratio (HR) = 1.7, 95% confidence interval (CI) =1.0-2.9, P = 0.04], stage IV (HR = 3.2, 95% CI = 1.7-5.9, P < 0.001), and hormonal hypersecretion (HR = 2.6, 95% CI = 1.5-4.2, P < 0.001) were associated with worse RFS. When applying this model to OS, similar associations were seen (transfusion HR = 2.0, 95% CI = 1.1-3.8, P = 0.02; stage 4 HR = 6.2, 95% CI = 3.1-12.4, P < 0.001; hormonal hypersecretion HR = 3.5, 95% CI = 1.9-6.4, P < 0.001). There was no difference in outcomes between patients who received 1 to 2 units versus >2 units of packed red blood cells in median RFS (8.9 vs 8.4 months, P = 0.95) or OS (26.5 vs 18.6 months, P = 0.63). Perioperative transfusion is associated with earlier recurrence and decreased survival after curative-intent resection of ACC. Strategies and protocols to minimize blood transfusion should be developed and followed.

Published
2017

8. Minimally Invasive Resection of Adrenocortical Carcinoma: a Multi-Institutional Study of 201 Patients.

Author

Lee, Christina W, Salem, Ahmed I, Schneider, David F, Leverson, Glen E, Tran, Thuy B, Poultsides, George A, Postlewait, Lauren M, Maithel, Shishir K, Wang, Tracy S, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E, Shirley, Lawrence, Fields, Ryan C, Jin, Linda X, Pawlik, Timothy M, Prescott, Jason D, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, and Weber, Sharon M

Subjects
Humans, Adrenocortical Carcinoma, Adrenal Cortex Neoplasms, Prognosis, Disease-Free Survival, Adrenalectomy, Survival Rate, Retrospective Studies, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Young Adult, Minimally Invasive Surgical Procedures, Adrenocortical carcinoma, Disease-free survival, Minimally invasive surgery, Surgical approach, Survival, Clinical Research, Cancer, 6.4 Surgery, Clinical Sciences, Surgery
Abstract

Background and objectivesMinimally invasive surgery for adrenocortical carcinoma (ACC) is controversial. We sought to evaluate the perioperative and long-term outcomes following minimally invasive (MIS) and open resection (OA) of ACC in patients treated with curative intent surgery.MethodsRetrospective data from patients who underwent adrenalectomy for primary ACC at 13 tertiary care cancer centers were analyzed, including demographics, clinicopathological, and operative outcomes. Outcomes following MIS were compared to OA.ResultsA total of 201 patients were evaluated including 47 MIS and 154 OA. There was no difference in utilization of MIS approach among institutions (p = 0.24) or 30-day morbidity (29.3 %, MIS, vs. 30.9 %, OA; p = 0.839). The only preoperatively determined predictor for MIS was smaller tumor size (p

Published
2017

9. Curative Surgical Resection of Adrenocortical Carcinoma: Determining Long-term Outcome Based on Conditional Disease-free Probability.

Author

Kim, Yuhree, Margonis, Georgios A, Prescott, Jason D, Tran, Thuy B, Postlewait, Lauren M, Maithel, Shishir K, Wang, Tracy S, Glenn, Jason A, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Poultsides, George A, and Pawlik, Timothy M

Subjects
Humans, Adrenocortical Carcinoma, Adrenal Cortex Neoplasms, Disease-Free Survival, Treatment Outcome, Proportional Hazards Models, Follow-Up Studies, Databases, Factual, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Young Adult, Surgery, Medical and Health Sciences
Abstract

ObjectiveTo evaluate conditional disease-free survival (CDFS) for patients who underwent curative intent surgery for adrenocortical carcinoma (ACC).BackgroundACC is a rare but aggressive tumor. Survival estimates are usually reported as survival from the time of surgery. CDFS estimates may be more clinically relevant by accounting for the changing likelihood of disease-free survival (DFS) according to time elapsed after surgery.MethodsCDFS was assessed using a multi-institutional cohort of patients. Cox proportional hazards models were used to evaluate factors associated with DFS. Three-year CDFS (CDFS3) estimates at "x" year after surgery were calculated as follows: CDFS3 = DFS(x+3)/DFS(x).ResultsOne hundred ninety-two patients were included in the study cohort; median patient age was 52 years. On presentation, 36% of patients had a functional tumor and median size was 11.5 cm. Most patients underwent R0 resection (75%) and 9% had N1 disease. Overall 1-, 3-, and 5-year DFS was 59%, 34%, and 22%, respectively. Using CDFS estimates, the probability of remaining disease free for an additional 3 years given that the patient had survived without disease at 1, 3, and 5 years, was 43%, 53%, and 70%, respectively. Patients with less favorable prognosis at baseline demonstrated the greatest increase in CDFS3 over time (eg, capsular invasion: 28%-88%, Δ60% vs no capsular invasion: 51%-87%, Δ36%).ConclusionsDFS estimates for patients with ACC improved dramatically over time, in particular among patients with initial worse prognoses. CDFS estimates may provide more clinically relevant information about the changing likelihood of DFS over time.

Published
2017

10. Lymphadenectomy for Adrenocortical Carcinoma: Is There a Therapeutic Benefit?

Author

Gerry, Jon M, Tran, Thuy B, Postlewait, Lauren M, Maithel, Shishir K, Prescott, Jason D, Wang, Tracy S, Glenn, Jason A, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Hatzaras, Ioannis, Shenoy, Rivfka, Pawlik, Timothy M, Norton, Jeffrey A, and Poultsides, George A

Subjects
Oncology & Carcinogenesis, Oncology and Carcinogenesis
Published
2016

11. Actual 10-year survivors following resection of adrenocortical carcinoma.

Author

Tran, Thuy B, Postlewait, Lauren M, Maithel, Shishir K, Prescott, Jason D, Wang, Tracy S, Glenn, Jason, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Hatzaras, Ioannis, Shenoy, Rivfka, Pawlik, Timothy M, Norton, Jeffrey A, and Poultsides, George A

Subjects
Humans, Adrenocortical Carcinoma, Adrenal Cortex Neoplasms, Treatment Outcome, Survival Analysis, Follow-Up Studies, Databases, Factual, Adult, Aged, Middle Aged, United States, Female, Male, adrenal cancer, adrenocortical carcinoma, surgery, survival, Clinical Research, Cancer, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Good Health and Well Being, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

BackgroundAdrenocortical carcinoma (ACC) is a rare and aggressive malignancy with limited therapeutic options beyond surgical resection. The characteristics of actual long-term survivors following surgical resection for ACC have not been previously reported.MethodPatients who underwent resection for ACC at one of 13 academic institutions participating in the US Adrenocortical Carcinoma Group from 1993 to 2014 were analyzed. Patients were stratified into four groups: early mortality (died within 2 years), late mortality (died within 2-5 years), actual 5-year survivor (survived at least 5 years), and actual 10-year survivor (survived at least 10 years). Patients with less than 5 years of follow-up were excluded.ResultsAmong the 180 patients available for analysis, there were 49 actual 5-year survivors (27%) and 12 actual 10-year survivors (7%). Patients who experienced early mortality had higher rates of cortisol-secreting tumors, nodal metastasis, synchronous distant metastasis, and R1 or R2 resections (all P

Published
2016

13. Features of synchronous versus metachronous metastasectomy in adrenal cortical carcinoma: Analysis from the US adrenocortical carcinoma database

Author

Prendergast, Katherine M., Smith, Paula Marincola, Tran, Thuy B., Postlewait, Lauren M., Maithel, Shishir K., Prescott, Jason D., Pawlik, Timothy M., Wang, Tracy S., Glenn, Jason, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E., Shirley, Lawrence A., Fields, Ryan C., Jin, Linda X., Weber, Sharon M., Salem, Ahmed, Sicklick, Jason K., Gad, Shady, Yopp, Adam C., Mansour, John C., Duh, Quan-Yang, Seiser, Natalie, Votanopoulos, Konstantinos I., Levine, Edward A., Poultsides, George A., Solórzano, Carmen C., and Kiernan, Colleen M.

Published
2020
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14. Outcomes of Adjuvant Mitotane after Resection of Adrenocortical Carcinoma: A 13-Institution Study by the US Adrenocortical Carcinoma Group.

Author

Postlewait, Lauren M, Ethun, Cecilia G, Tran, Thuy B, Prescott, Jason D, Pawlik, Timothy M, Wang, Tracy S, Glenn, Jason, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Staley, Charles A, Poultsides, George A, and Maithel, Shishir K

Subjects
Humans, Adrenocortical Carcinoma, Adrenal Cortex Neoplasms, Mitotane, Antineoplastic Agents, Hormonal, Disease-Free Survival, Treatment Outcome, Chemotherapy, Adjuvant, Adrenalectomy, Retrospective Studies, Adult, Aged, Middle Aged, United States, Female, Male, Cancer, Clinical Trials and Supportive Activities, Clinical Research, Patient Safety, 6.1 Pharmaceuticals, Surgery, Clinical Sciences
Abstract

BackgroundCurrent treatment guidelines recommend adjuvant mitotane after resection of adrenocortical carcinoma with high-risk features (eg, tumor rupture, positive margins, positive lymph nodes, high grade, elevated mitotic index, and advanced stage). Limited data exist on the outcomes associated with these practice guidelines.Study designPatients who underwent resection of adrenocortical carcinoma from 1993 to 2014 at the 13 academic institutions of the US Adrenocortical Carcinoma Group were included. Factors associated with mitotane administration were determined. Primary end points were recurrence-free survival (RFS) and overall survival (OS).ResultsOf 207 patients, 88 (43%) received adjuvant mitotane. Receipt of mitotane was associated with hormonal secretion (58% vs 32%; p = 0.001), advanced TNM stage (stage IV: 42% vs 23%; p = 0.021), adjuvant chemotherapy (37% vs 5%; p < 0.001), and adjuvant radiation (17% vs 5%; p = 0.01), but was not associated with tumor rupture, margin status, or N-stage. Median follow-up was 44 months. Adjuvant mitotane was associated with decreased RFS (10.0 vs 27.9 months; p = 0.007) and OS (31.7 vs 58.9 months; p = 0.006). On multivariable analysis, mitotane was not independently associated with RFS or OS, and margin status, advanced TNM stage, and receipt of chemotherapy were associated with survival. After excluding all patients who received chemotherapy, adjuvant mitotane remained associated with decreased RFS and similar OS; multivariable analyses again showed no association with recurrence or survival. Stage-specific analyses in both cohorts revealed no association between adjuvant mitotane and improved RFS or OS.ConclusionsWhen accounting for stage and adverse tumor and treatment-related factors, adjuvant mitotane after resection of adrenocortical carcinoma is not associated with improved RFS or OS. Current guidelines should be revisited and prospective trials are needed.

Published
2016

15. Nomograms to Predict Recurrence-Free and Overall Survival After Curative Resection of Adrenocortical Carcinoma.

Author

Kim, Yuhree, Margonis, Georgios A, Prescott, Jason D, Tran, Thuy B, Postlewait, Lauren M, Maithel, Shishir K, Wang, Tracy S, Evans, Douglas B, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed I, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Poultsides, George A, and Pawlik, Timothy M

Subjects
Humans, Adrenocortical Carcinoma, Adrenal Cortex Neoplasms, Neoplasm Recurrence, Local, Prognosis, Disease-Free Survival, Adrenalectomy, Postoperative Period, Incidence, Survival Rate, Nomograms, Adult, Middle Aged, United States, Female, Male, Cancer, Patient Safety, Clinical Research
Abstract

ImportanceAdrenocortical carcinoma (ACC) is a rare but aggressive endocrine tumor, and the prognostic factors associated with long-term outcomes after surgical resection remain poorly defined.ObjectivesTo define clinicopathological variables associated with recurrence-free survival (RFS) and overall survival (OS) after curative surgical resection of ACC and to propose nomograms for individual risk prediction.Design, setting, and participantsNomograms to predict RFS and OS after surgical resection of ACC were proposed using a multi-institutional cohort of patients who underwent curative-intent surgery for ACC at 13 major institutions in the United States between March 17, 1994, and December 22, 2014. The dates of our study analysis were April 15, 2015, to May 12, 2015.Main outcomes and measuresThe discriminative ability and calibration of the nomograms to predict RFS and OS were tested using C statistics, calibration plots, and Kaplan-Meier curves.ResultsIn total, 148 patients who underwent surgery for ACC were included in the study. The median patient age was 53 years, and 65.5% (97 of 148) of the patients were female. One-third of the patients (35.1% [52 of 148]) had a functional tumor, and the median tumor size was 11.2 cm. Most patients (77.7% [115 of 148]) underwent R0 resection, and 8.8% (13 of 148) of the patients had N1 disease. Using backward stepwise selection of clinically important variables with the Akaike information criterion, the following variables were incorporated in the prediction of RFS: tumor size of at least 12 cm (hazard ratio [HR], 3.00; 95% CI, 1.63-5.70; P

Published
2016

16. Adrenocortical Carcinoma: Impact of Surgical Margin Status on Long-Term Outcomes

Author

Margonis, Georgios Antonios, Kim, Yuhree, Prescott, Jason D, Tran, Thuy B, Postlewait, Lauren M, Maithel, Shishir K, Wang, Tracy S, Evans, Douglas B, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Poultsides, George A, and Pawlik, Timothy M

Subjects
Clinical Research, Cancer, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Adrenal Cortex Neoplasms, Adrenocortical Carcinoma, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Postoperative Complications, Prognosis, Survival Rate, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

BackgroundThe influence of surgical margin status on long-term outcomes of patients undergoing adrenal resection for ACC remains not well defined. We studied the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ACC.MethodsA total of 165 patients who underwent adrenal resection for ACC and met inclusion criteria were identified form a multi-institutional database. Clinicopathological data, pathologic margin status, and long-term outcomes were assessed. Patients were stratified into two groups based on margin status: R0 (margin >1 mm) versus R1.ResultsR0 resection was achieved in 126 patients (76.4 %), whereas 39 patients (23.6 %) had an R1 resection. Median and 5-year OS for patients undergoing R0 resection were 96.3 months and 64.8 % versus 25.1 months and 33.8 % for patients undergoing an R1 resection (both p < 0.001). On multivariable analysis, surgical margin status was an independent predictor of worse OS (hazard ratio [HR] 2.22, 95 % confidence interval [CI] 1.03-4.77; p = 0.04). The incidence of recurrence also differed between the two groups; 5-year RFS was 30.3 % among patients with an R0 resection versus 13.8 % among patients who had an R1 resection (p = 0.03). Lymph node metastasis (N1) was an independent predictor of RFS (HR 2.70, 95 % CI 1.04-6.99; p = 0.04).ConclusionsA positive margin after ACC resection was associated with worse long-term survival. Patient selection and an emphasis on surgical technique to achieve R0 margins are pivotal to optimizing the best chance for long-term outcome among patients with ACC.

Published
2016

17. Curative Surgical Resection of Adrenocortical Carcinoma: Determining Long-term Outcome Based on Conditional Disease-free Probability.

Author

Kim, Yuhree, Margonis, Georgios A, Prescott, Jason D, Tran, Thuy B, Postlewait, Lauren M, Maithel, Shishir K, Wang, Tracy S, Glenn, Jason A, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E, Keplinger, Kara, Fields, Ryan C, Jin, Linda X, Weber, Sharon M, Salem, Ahmed, Sicklick, Jason K, Gad, Shady, Yopp, Adam C, Mansour, John C, Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C, Kiernan, Colleen M, Votanopoulos, Konstantinos I, Levine, Edward A, Poultsides, George A, and Pawlik, Timothy M

Subjects
adrenocortical carcinoma, conditional probability, outcomes, surgery, Cancer, Clinical Research, Patient Safety, Surgery, Medical and Health Sciences
Abstract

To evaluate conditional disease-free survival (CDFS) for patients who underwent curative intent surgery for adrenocortical carcinoma (ACC).ACC is a rare but aggressive tumor. Survival estimates are usually reported as survival from the time of surgery. CDFS estimates may be more clinically relevant by accounting for the changing likelihood of disease-free survival (DFS) according to time elapsed after surgery.CDFS was assessed using a multi-institutional cohort of patients. Cox proportional hazards models were used to evaluate factors associated with DFS. Three-year CDFS (CDFS3) estimates at "x" year after surgery were calculated as follows: CDFS3 = DFS(x+3)/DFS(x).One hundred ninety-two patients were included in the study cohort; median patient age was 52 years. On presentation, 36% of patients had a functional tumor and median size was 11.5 cm. Most patients underwent R0 resection (75%) and 9% had N1 disease. Overall 1-, 3-, and 5-year DFS was 59%, 34%, and 22%, respectively. Using CDFS estimates, the probability of remaining disease free for an additional 3 years given that the patient had survived without disease at 1, 3, and 5 years, was 43%, 53%, and 70%, respectively. Patients with less favorable prognosis at baseline demonstrated the greatest increase in CDFS3 over time (eg, capsular invasion: 28%-88%, Δ60% vs no capsular invasion: 51%-87%, Δ36%).DFS estimates for patients with ACC improved dramatically over time, in particular among patients with initial worse prognoses. CDFS estimates may provide more clinically relevant information about the changing likelihood of DFS over time.

Published
2015

24. A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the US Adrenocortical Carcinoma Study Group

Author

Poorman, Caroline E., Ethun, Cecilia G., Postlewait, Lauren M., Tran, Thuy B., Prescott, Jason D., Pawlik, Timothy M., Wang, Tracy S., Glenn, Jason, Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E., Keplinger, Kara, Fields, Ryan C., Jin, Linda X., Weber, Sharon M., Salem, Ahmed, Sicklick, Jason K., Gad, Shady, Yopp, Adam C., Mansour, John C., Duh, Quan-Yang, Seiser, Natalie, Solórzano, Carmen C., Kiernan, Colleen M., Votanopoulos, Konstantinos I., Levine, Edward A., Staley, Charles A., Poultsides, George A., and Maithel, Shishir K.

Published
2017
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30. Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma

Author

Valero-Elizondo, Javier, Kim, Yuhree, Prescott, Jason D., Margonis, Georgios A., Tran, Thuy B., Postlewait, Lauren M., Maithel, Shishir K., Wang, Tracy S., Glenn, Jason A., Hatzaras, Ioannis, Shenoy, Rivfka, Phay, John E., Keplinger, Kara, Fields, Ryan C., Jin, Linda X., Weber, Sharon M., Salem, Ahmed, Sicklick, Jason K., Gad, Shady, Yopp, Adam C., Mansour, John C., Duh, Quan-Yang, Seiser, Natalie, Solorzano, Carmen C., Kiernan, Colleen M., Votanopoulos, Konstantinos I., Levine, Edward A., Poultsides, George A., and Pawlik, Timothy M.

Published
2015
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40. A multi-institutional international study of risk factors for hematoma after thyroidectomy

Author

Campbell, Michael J., McCoy, Kelly L., Shen, Wen T., Carty, Sally E., Lubitz, Carrie C., Moalem, Jacob, Nehs, Matthew, Holm, Tammy, Greenblatt, David Y., Press, Danielle, Feng, Xiaoxi, Siperstein, Allan E., Mitmaker, Elliot, Benay, Cassandre, Tabah, Roger, Oltmann, Sarah C., Chen, Herbert, Sippel, Rebecca S., Brekke, Andrew, Vriens, Menno R., Lodewijk, Lutske, Stephen, Antonia E., Nagar, Sapna, Angelos, Peter, Ghanem, Maher, Prescott, Jason D., Zeiger, Martha A., Han, Patricia Aragon, Sturgeon, Cord, Elaraj, Dina M., Nixon, Iain J., Patel, Snehal G., Bayles, Stephen W., Heneghan, Rachel, Ochieng, Peter, Guerrero, Marlon A., and Ruan, Daniel T.

Published
2013
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44. Contributors

Author

Abcarian, Herand, primary, Abdullah, Fizan, additional, Abramson, Michael A., additional, Abularrage, Christopher J., additional, Adams, Reid B., additional, Adamski, John., additional, Ahrendt, Steven A., additional, Ahuja, Nita, additional, Alam, Hasan B., additional, Alverdy, John C., additional, Armstrong, David N., additional, Arnaoutakis, George J., additional, Arnold, Alejandro, additional, Arthurs, Zachary M., additional, Asbun, Horacio J., additional, Ascher, Nancy L., additional, Asgeirsson, Theodor, additional, Ashley, Stanley W., additional, Babiera, Gildy V., additional, Balcom, James H., additional, Balogh, Zsolt J., additional, Banki, Farzaneh, additional, Barbul, Adrian, additional, Barie, Philip S., additional, Bauer, Todd W., additional, Beck, David E., additional, Bedri, Mazen I., additional, Berenji, Manijeh, additional, Berger, David L., additional, Bergman, Thomas A., additional, Berry, Stepheny D., additional, Billingham, Richard P., additional, Birnbaum, Elisa H., additional, Black, James H., additional, Bland, Kirby I., additional, Bochicchio, Grant V., additional, Bouchard, Philippe, additional, Boughey, Judy C., additional, Bowers, Steven P., additional, Brady, Colin M., additional, Brandes, Steven B., additional, Brant-Zawadzki, Peter, additional, Brayman, Kenneth L., additional, Brethauer, Stacy A., additional, Brock, Malcolm V., additional, Brooke, Benjamin S., additional, Broome, James T., additional, Brown, Carl J., additional, Brunicardi, F. Charles, additional, Brushart, Thomas M., additional, Buchman, Timothy G., additional, Bulger, Eileen M., additional, Burns, J. Bracken, additional, Busuttil, Ronald W., additional, Byrne, John, additional, Callender, Glenda G., additional, Callery, Mark P., additional, Cambria, Richard P., additional, Cameron, Andrew M., additional, Cameron, John L., additional, Campsen, Jeffrey, additional, Caprini, Joseph A., additional, Carter, Jonathan, additional, Caudle, Abigail S., additional, Ceppa, Eugene P., additional, Cevasco, Marisa, additional, Chaikof, Elliot L., additional, Chalikonda, Sricharan, additional, Chandrasekhara, Vinay, additional, Chaudhry, Vivek, additional, Chen, Haiquan, additional, Chen, Herbert, additional, Cheng, Aaron M., additional, Choti, Michael A., additional, Christians, Kathleen K., additional, Christmas, A. Britton, additional, Chua, Heidi, additional, Chun, Albert K., additional, Chung, Alice, additional, Clark, Orlo H., additional, Cleary, Sean P., additional, Cocanour, Christine S., additional, Codner, Panna A., additional, Cogbill, Thomas H., additional, Collier, Patrick S., additional, Conrad, Mark F., additional, Cooper, Joel D., additional, Corning, Cybil, additional, Cortes, Vicente, additional, Coselli, Joseph S., additional, Craft, Randall O., additional, Croce, Martin A., additional, Crow, Jessica, additional, Cuff, Robert F., additional, Cullen, Joseph J., additional, Cunningham, Steven C., additional, Curet, Myriam J., additional, Dackiw, Alan P.B., additional, Dagher, Nabil N., additional, Darling, R. Clement, additional, Davidson, Nancy E., additional, Degliuomini, John J., additional, Degnim, Amy C., additional, Delaney, Conor P., additional, DeMatteo, Ronald P., additional, DeMeester, Steven R., additional, DeMeester, Tom R., additional, Dempsey, Daniel T., additional, deSouza, Ashwin L., additional, Deune, E. Gene, additional, DeVos, Wayne C., additional, Dimick, Justin B., additional, Donahue, Timothy R., additional, Dort, Jonathan M., additional, Dozois, Eric J., additional, Dreesen, Elizabeth, additional, Duh, Quan-Yang, additional, Dulchavsky, Scott A., additional, Duncan, Mark D., additional, Duvvuri, Umamaheshwar, additional, Eachempati, Soumitra R., additional, Eakin, Jeffrey, additional, Eckhauser, Frederic E., additional, Edil, Barish H., additional, Edwards, Eric D., additional, Edwards, Meghan, additional, Efron, David T., additional, Efron, Jonathan E., additional, Efron, Philip A., additional, Ellison, E. Christopher, additional, Ellison, Trevor A., additional, El Sherif, Amgad, additional, Escobar, Guillermo A., additional, Esposito, Domenic P., additional, Evans, Douglas B., additional, Evans, Heather L., additional, Fabri, Peter J., additional, Fairman, Ronald M., additional, Farres, Houssam, additional, Feins, Richard H., additional, Feliciano, David V., additional, Ferguson, Charles M., additional, Ferguson, Mark K., additional, Ferrone, Cristina R., additional, Ferzli, George S., additional, Fichera, Alessandro, additional, Fink, Aaron S., additional, Fink, David, additional, Fishel, Rhonda, additional, Fisher, Kerry, additional, Fisher, William E., additional, Fitzgibbons, Timothy C., additional, Fleshman, James W., additional, Flint, Lewis M., additional, Flohr, Tanya R., additional, Flores, Jaime I., additional, Fogarty, Sara P., additional, Foley, Paul J., additional, Fong, Yuman, additional, Friel, Charles M., additional, Frykberg, Eric R., additional, Fuller, Joseph C., additional, Gadd, Michele A., additional, Gailloud, Philippe, additional, Galanis, Charles, additional, Gallagher, James J., additional, Gallagher, Scott F., additional, Gaspard, Bryan A., additional, Gaughan, Colleen B., additional, Gearhart, Susan L., additional, Geller, David A., additional, Georgiades, Christos S., additional, Geschwind, Jean-Francois H., additional, Ghosheh, Bashar, additional, Giday, Samuel A., additional, Giuliano, Armando E., additional, Glebova, Natalia, additional, Goldberg, Nelson H., additional, Goldstone, Jerry, additional, Golla, Suman, additional, Gosnell, Jessica E., additional, Gourley, Jeffrey R., additional, Graham, Jay A., additional, Grams, Jayleen, additional, Grant, Michael P., additional, Grau, Ana M., additional, Grothey, Axel, additional, Guerrero, Marlon A., additional, Guillem, Jose G., additional, Haider, Adil H., additional, Hall, Bruce Lee, additional, Han, David C., additional, Harmon, John W., additional, Harold, Kristi L., additional, Harper, Amy P., additional, Harris, Hobart W., additional, Hashimi, Samad, additional, Hassoun, Heitham T., additional, Haut, Elliott R., additional, Hébert-Blouin, Marie-Noëlle, additional, Heitmiller, Richard F., additional, Henderson, J. Michael, additional, Heniford, B. Todd, additional, Henke, Peter K., additional, Herlong, H. Franklin, additional, Hernandez, Jonathan M., additional, Hess, Philip J., additional, Hiatt, Jonathan R., additional, Hines, O. Joe, additional, Hodin, Richard A., additional, Hoffman, John P., additional, Hong, Johnny C., additional, Hoppo, Toshitaka, additional, Horn, Jan K., additional, Hornicek, Francis J., additional, Hossain, Rydhwana, additional, Howard, Thomas J., additional, Hoyt, David B., additional, Hrabe, Jennifer E., additional, Hranjec, Tjasa, additional, Hull, Tracy L., additional, Iannettoni, Mark D., additional, Iannitti, David A., additional, Idrees, Kamran, additional, Ignacio, Elizabeth A., additional, Iseli, Tim A., additional, Ito, Hiromichi, additional, Jacene, Heather, additional, Jackson, Lana L., additional, Jacobs, Lenworth M., additional, Jacobs, Lisa K., additional, Jagannath, Sanjay, additional, Jaszczak, Nicholas, additional, Jayaraman, Vijay, additional, Jimenez, Juan Carlos, additional, Jin, Judy, additional, Jobe, Blair A., additional, Joh, Jennifer E., additional, Johnson, Eric K., additional, Johnson, Jonas T., additional, Johnson, Lynt B., additional, Johnson, Michael, additional, Jonnalagadda, Sreenivasa, additional, Jurkovich, Gregory J., additional, Kachala, Stefan S., additional, Kalloo, Anthony N., additional, Karakousis, Giorgos C., additional, Katz, Ryan D., additional, Keane, Thomas, additional, Kebebew, Electron, additional, Kent, K. Craig, additional, Kent, Tara S., additional, Khashab, Mouen, additional, Kilic, Arman, additional, Hui Kim, Elizabeth Min, additional, Kim, Yongsik, additional, King, Jonathan C., additional, King, Tari A., additional, Kirkpatrick, Andrew W., additional, Kong, Allen, additional, Kozarek, Richard A., additional, Krasna, Mark J., additional, Krontiras, Helen, additional, Kuwayama, David, additional, Lai, Edward C.S., additional, Lal, Alysandra, additional, LaMuraglia, Glenn M., additional, Lau, Kwan N., additional, Lavu, Harish, additional, Lawrence, Peter F., additional, LeBlanc, Karl A., additional, Ledgerwood, Anna M., additional, LeMaire, Scott A., additional, Lembersky, Barry C., additional, Leukhardt, William H., additional, Li, Ryan, additional, Lillemoe, Keith D., additional, Lipsett, Pamela A., additional, Lipsitz, Evan C., additional, Little, Alex G., additional, Lucas, Charles E., additional, Luketich, James D., additional, Lum, Ying Wei, additional, Lyden, Sean P., additional, MacFadyen, Bruce V., additional, Madariaga, Maria Lucia L., additional, Magnuson, Thomas H., additional, Maier, Ronald V., additional, Makary, Martin A., additional, Makhija, Rohit, additional, Malangoni, Mark A., additional, Malas, Mahmoud B., additional, Manson, Paul N., additional, Marcello, Peter W., additional, Marks, Jeffrey M., additional, Marohn, Michael R., additional, Martin, Terri R., additional, Martin, Tomas D., additional, Mathisen, Douglas J., additional, Matthews, Brent D., additional, Mazzaglia, Peter J., additional, McDermott, John E., additional, McFadden, David W., additional, McHenry, Christopher R., additional, McIntyre, Robert C., additional, McLemore, Elisabeth C., additional, McLeod, Robin S., additional, Mellinger, John D., additional, Melo, Nicholas, additional, Melton, Genevieve B., additional, Meltzer, Andrew J., additional, Melvin, W. Scott, additional, Mendoza, Maria Clara, additional, Messiner, Ryan, additional, Meyer, Anthony A., additional, Meyers, William C., additional, Michelassi, Fabrizio, additional, Millikan, Keith W., additional, Miner, Thomas J., additional, Moley, Jeffrey F., additional, Moore, Frederick A., additional, Morrow, Ellen H., additional, Morrow, Monica, additional, Moss, Angela K., additional, Moustarah, Fady, additional, Mufeed, Sami, additional, Muldoon, Roberta L., additional, Muniappan, Ashok, additional, Murphy, Erin H., additional, Muscarella, Peter, additional, Nahabedian, Maurice Y., additional, Napolitano, Lena M., additional, Nealon, William H., additional, Neideen, Todd, additional, Neumayer, Leigh A., additional, Newman, Naeem A., additional, Nguyen, Hien T., additional, Nguyen, Kevin Tri, additional, Nikfarjam, Mehrdad, additional, Norton, Jeffrey A., additional, O'Mara, Charles S., additional, Onders, Raymond P., additional, Pachter, H. Leon, additional, Pappas, Theodore N., additional, Parikh, Manish, additional, Park, Jason, additional, Pascual, Jose L., additional, Patel, Virendra I., additional, Pearl, Russell K., additional, Peitzman, Andrew B., additional, Pemberton, John H., additional, Perler, Bruce A., additional, Perrier, Nancy D., additional, Pesce, Catherine E., additional, Petelin, Joseph B., additional, Peters, Jeffrey H., additional, Petrowsky, Henrik, additional, Pfluke, Jason M., additional, Philipp, Scott R., additional, Phillips, Bradley J., additional, Piper, Greta L., additional, Pitt, Henry A., additional, Pizano, Louis R., additional, Ponsky, Jeffrey L., additional, Prescott, Jason D., additional, Pronovost, Peter J., additional, Pust, Gerd D., additional, Pustavoitau, Aliaksei, additional, Puyana, Juan Carlos, additional, Qazi, Umair, additional, Quickel, Robert R., additional, Ra, Jin H., additional, Rad, Ariel N., additional, Radvany, Martin G., additional, Rafferty, Janice F., additional, Rahbari, Reza, additional, Ramos, Margarita, additional, Ramshaw, Bruce J., additional, Rawlings, Arthur, additional, Reardon, Patrick R., additional, Reber, Howard A., additional, Reeder, Jennifer G., additional, Reidy, Tobi, additional, Reifsnyder, Andrew, additional, Reifsnyder, Thomas F., additional, Resnick, Andrew S., additional, Richards, William O., additional, Rieder, Erwin, additional, Roberts, John P., additional, Robinson, Raymond E., additional, Robinson, Thomas N., additional, Rodriguez, Aurelio, additional, Rodriguez-Paz, Jose M., additional, Rogers, Selwyn O., additional, Romig, Mark, additional, Roseborough, Glen S., additional, Rosemurgy, Alexander S., additional, Rosenthal, Eben L., additional, Rossi, Daniel C., additional, Rosson, Gedge D., additional, Safar, Bashar, additional, Salky, Barry A., additional, Santora, Rachel J., additional, Sarin, Shawn N., additional, Sawyer, Robert G., additional, Sax, Harry C., additional, Scalea, Thomas M., additional, Schauer, Philip R., additional, Schild, A. Frederick, additional, Schmidt, C. Max, additional, Schneider, John G., additional, Schreiber, Martin A., additional, Schuerer, Douglas J.E., additional, Schulick, Richard D., additional, Schwab, C. William, additional, Schweitzer, Michael A., additional, Scortino, Christopher, additional, Senagore, Anthony J., additional, Sentovich, Stephen M., additional, Sepesi, Boris, additional, Seybt, Melanie W., additional, Shah, Amit, additional, Shellito, Paul C., additional, Shepard, Alexander D., additional, Shetty, Kirti, additional, Sicklick, Jason K., additional, Silberfein, Eric J., additional, Silverman, Ronald P., additional, Simmons, Rache M., additional, Sing, Ronald F., additional, Smith, Barbara L., additional, Smith, C. Daniel, additional, Smith, Maurice A., additional, Smith, R. Stephen, additional, Snyder, Michael J., additional, Sohn, Helen, additional, Soybel, David I., additional, Spencer, Michael P., additional, Spinner, Robert J., additional, Spoerke, Nicholas J., additional, Steele, Scott R., additional, Stein, Sharon L., additional, Stevens, Kent A., additional, Sticca, Robert P., additional, Stiegmann, Gregory V., additional, Stonemetz, Jerry, additional, Strasberg, Steven M., additional, Streiff, Michael B., additional, Su, Stacey, additional, Sucher, Joseph F., additional, Sussman, Marc, additional, Sutherland, David E.R., additional, Swanstrom, Lee L., additional, Taghizadeh, Maakan, additional, Talamini, Mark A., additional, Tarpley, John L., additional, Tatli, Servet, additional, Taylor, Spence M., additional, Terris, David J., additional, Thompson, Geoffrey B., additional, Traverso, L. William, additional, Trunkey, Donald D., additional, Tsai, Peter I., additional, Tsai, Susan, additional, Tsangaris, Theodore N., additional, Udelsman, Robert, additional, Umanskiy, Konstantin, additional, Upchurch, Gilbert R., additional, Urist, Marshall M., additional, Urschel, Harold C., additional, Vagefi, Parsia A., additional, Van, Philbert Y., additional, Van Arendonk, Kyle J., additional, Vauthey, Jean-Nicolas, additional, Veeramachaneni, Nirmal K., additional, Velmahos, George C., additional, Venbrux, Anthony C., additional, Vollmer, Charles M., additional, Wacker, Frank K., additional, Wallack, Marc K., additional, Walsh, R. Matthew, additional, Wang, Grace J., additional, Wang, Jennifer Y., additional, Wang, Thomas N., additional, Waters, Joshua A., additional, Watkins, Michael T., additional, Watson, Christopher M., additional, Webb, Alexandra L.B., additional, Weigelt, John A., additional, Weiss, Eric G., additional, Whang, Edward E., additional, Whitacre, Eric B., additional, Williams, D. Brandon, additional, Wolff, Bruce G., additional, Wolfgang, Christopher, additional, Wong, Patricia, additional, Wood, Douglas E., additional, Yadav, Bhupender, additional, Yang, Stephen C., additional, Yeo, Charles J., additional, Yoon, Sam S., additional, You, Christopher J., additional, You, Y. Nancy, additional, Youssef, Yassar, additional, Zalinski, Stéphane, additional, Zamir, Gideon A., additional, Zarins, Christopher K., additional, Zeiger, Martha A., additional, Zenilman, Michael E., additional, and Zimmerman, Michael A., additional

Published
2011
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46. Colaboradores

Author

Ahmadi, Sara, Akula, Monika S., Alexander, Erik K., Angell, Trevor E., Anderson, Maureen McCartney, Bilezikian, John P., Bornstein, Stefan Richard, Calissendorff, Jan, Campbell, Stuart, Chukir, Tariq, Corrigan, Tara, Falhammar, Henrik, Farooki, Azeez, Flippo, Chelsi, Frasier, Lane L., Gemma, Vincent, Girotra, Monica, Goel, Ansha, Goodier, Christopher G., Guzman, Heidi, Ishii, Makoto, Ito, Yasuhiro, Kazim, Michael, Keating, Jane J., Kotwal, Anupam, Krasnova, Svetlana L., Lam, David W., Lechner, Melissa G., Loftley, Aundrea Eason, Lubitz, Sara E., Mandel, Louis, Masuoka, Hiroo, Mestman, Jorge H., Miyauchi, Akira, Nguyen, Caroline T., Ong, Raquel Kristin Sanchez, Owen, Randall P., Pommier, Rodney F., Prescott, Jason D., Punati, Ramya, Romero-Velez, Gustavo, Schneider, Arthur B., Seitz, Alison P., Shifrin, Alexander L., Shiroff, Adam Michael, Stan, Marius N., Stratakis, Constantine A., Tatsi, Christina, Toft, Daniel J., Topilow, Arthur, Tran, Ann Q., Verbalis, Joseph G., Wartofsky, Leonard, Wonn, Sarah M., Ylli, Dorina, and Young, William F., Jr.

Published
2023
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47. Contributors

Author

Abcarian, Ariane M., Abcarian, Herand, Abdulhai, Mohamad A., Abularrage, Christopher J., AbuRahma, Ali F., AbuRahma, Zachary T., Adams, David B., Adams, Laura M., Adams, Reid B., Adekeye, Adeseye, Adrales, Gina L., Ahrendt, Gillian M., Ahrendt, Steven A., Ahuja, Nita, Akshintala, Venkata S., Efishat, Mohammad Al, Alam, Hasan B., Albaugh, Vance L., Albutt, Katherine, Alimi, Yewande, Alobuia, Wilson M., Alsaad, Ranim, Alvarenga, Emanuela Silva, Alverdy, John C., Amin, Avani, Andolfi, Ciro, Antognoli, Lauren, Aravind, Pathik, Arnold, Margaret W., Professor, Associate, Atallah, Chady, Axtell, Andrea L., Azad, Nilofer, Azizad, Omaira, Bales, Alison M., Barbul, Adrian, Barie, Philip S., Barnes, Emilie C., Barnes, Stephen L., Barnett, Erica, Basho, Reva, Bass, Gary A., Battafarano, Richard J., Bayard, Solange, Bedine, Marshall S., Behrns, Kevin E., Beliveau, Lauren, Benjamin, Elizabeth R., Berger, David, III, James H. Black, Blair, Alex B., Bomman, Shivanand, Bonds, Morgan, Boutros, Marylise, Brilliant, Justin, Britt, L.D., Broccard, Sacha P., Brock, Malcolm V., Broderick, Ryan C., Broderick, Stephen R., Brown, Lawrence B., Buckley, Jill C., Bunn, Corinne, Burke, Mark S., Burkhart, Richard A., Burnim, Michael S., Burns, William Reece, Bush, Errol L., Busuttil, Ronald W., Buyske, Jo, Calhoun, Kristine E., Calotta, Nicholas A., Cambria, Richard P., Camp, Melissa S., Cao, Yilin (Linda), Carp, Ned Z., Casciani, Fabio, Chaikof, Elliot L., Chatila, Ahmed, Chen, Sophia Y., Chi, Albert, Chilton, Timothy D., Cholewczynski, Walter, Choti, Michael A., Christensen, Joani, Christopher, Adrienne N., Chudnovets, Anna, Cintron, Jose R., Clary, Bryan M., Cloyd, Jordan M., Cocanour, Christine S., Coimbra, Raul, Colakoglu, Salih, Conyers, Julie A., III, Edward E. Cornwell, Coté, Gregory A., Cribari, Chris, Cronin, Patricia A., Crosby, Patrick, Cross, Alisa, Cunningham, Steven C., Dani, Hasan, Dardik, Alan, Darrach, Halley, Davidson, Whitney A., deAngeli, Katherine, Deery, Sarah E., Delitto, Daniel J., DeMeester, Tom R., Dempsey, Daniel T., Dennahy, Isabel S., Dent, Daniel L., DePeralta, Danielle K., Desai, Niraj M., DeSouza, Melissa Louise, DeStefano, Lauren M., Diggs, Laurence P., Dillon, Conor, DiNorcia, Joseph, Doherty, Gerard M., Donahue, James M., Done, Joy Zhou, Doucet, Jay J., Duh, Quan-Yang, Duncan, Mark D., Eckardt, Mark A., Edil, Barish H., Efron, David T., Efron, Jonathan E., Ehlers, Anne P., Eisenson, Daniel L., Haddi, S. James El, Moheb, Mohamad El, El-Diwany, Ramy, Elsey, James K., Elterman, Joel, Enumah, Zachary Obinna, Euhus, David M., Evans, Douglas B., C, Donald, Fadoul, Mikael A., Fagenholz, Peter J., Famularo, Marissa, Fang, Sandy Hwang, Farber, Alik, Fasano, Genevieve, Feliciano, David V., Feller-Kopman, MD, FACP, David J., Fergus, Kirkpatrick Beekman, Fernandez, Carlos, Fichera, Alessandro, Fischer, John P., Fish, Adam, Fisichella, P. Marco, Jr., James W. Fleshman, Florecki, Katherine L., Fong, Yuman, Fong, Zhi Ven, Fransman, Ryan B., Freischlag, Julie A., Frost, Christopher, Gabre-Kidan, Alodia, Gahtan, Vivian, Jr, Edward Hines, Galandiuk, Susan, Jr, Hiram C. Polk, Jr., Samuel M. Galvagno, Gao, Raisa, Garibaldi, Brian T., Garrido, Danon E., Gearhart, Susan L., Gemignani, Mary L., Georgiades, Christos, German, Zachary, Gewertz, Bruce L., Ghanem, Omar M., Giglia, Joseph S., Giuliano, Armando E., Glebova, Natalia O., Gleisner, Ana, Goeddel, Lee A., Goldberg, Eric M., Gonzalez, Reyna, Gore, Amy V., Goverman, Jeremy, Grandhi, Miral Sadaria, Grant, Michael D., Gray, Richard J., Greer, Jonathan B., Grewal, Mahip, Grimes, Chassidy, Grucz, Traci M., Grunwald, Matthew D., Guillem, Jose G., Gunter, Rebecca L., Gupta, NavYash, Habib, Joseph R., Habibi, Mehran, Hagen, Edward R., Haghshenas, Jafar, Halandras, Pegge M., Hamilton, James P., Hammami, Muhammad, Han, Britta Jean, Han, Misop, Handley, Guy, Harmon, John W., Harris, Andrew, Jr, James E. Harris, Harrison, Jon M., Haugen, Christine, Haut, Elliott R., Hayden, Dana, He, Jin, Herbella, Fernando A.M., Herman, Joseph M., Hickey, Sean, Hicks, Caitlin W., Hindin, David, Hines, O. Joe, Ho, Jessie, Hodin, Richard A., Houng, Abraham P., House, Michael G., Hoyt, David B., Hu, Yinin, Ijaz, Nadia, Inaba, Kenji, Ivey, Gabriel D., Jacobs, Lisa K., Janssen, Claire, Javed, Ammar A., John, Amballur David, Johnson, Eric K., Johnson, Wali Rashad, Johnston, Fabian M., Jones, Ronald C., Joseph, Bellal, Joshi, Girish P., Kaafarani, Haytham, Kalloo, Anthony N., Kaplan, Lewis J., Karzai, Shkala, Kashyap, Vikram S., Katlic, Mark, Kattah, Michael G., Kaups, Krista L., Kavousi, Yasaman, Kawaji, Qingwen, Kebaish, Khaled M., Kebebew, Electron, Kelley, Scott R., Kennard, Kaitlyn, Kent, Alistair J., Khadaroo, Rachel G., Khalifeh, Ali H., MD, Maria Abou Khalil, Khan, Hamza, Khan, Maryam Ali, Khan, Sameer, Khashab, Mouen A., Khodorskiy, Dmitriy O., Khreiss, Mohammad R., Kim, Jina, Kim, Joseph, Kim, Karen M., King, Elizabeth Gherardi, Kinny-Köster, Benedict, Klimberg, V. Suzanne, Koganti, Deepika, Kokosis, George, Kolarich, Andrew R., Kozarek, Richard, Krepline, Ashley, Kulkarni, Swati A., Kumbhari, Vivek, Kunisaki, Shaun M., Kwakye, Gifty, Ladd, Mitchell R., Lafaro, Kelly J., Laheru, Daniel A., Lancaster, William P., Lange, Julie R., Ledgerwood, Anna M., Lee, Christina, Lee, Eliza J., Lee, Grace C., Lee, Hanjoo, Levin, Adam S., Liddell, Robert P., Lillemoe, Heather A., Lillemoe, Keith D., Lipsett, Pamela A., Liveris, Anna, Livingston, David H., Loiacono, Laurie Anne, Lombardi, Joseph V., Low, Gregory K., Lowenfeld, Lea, Lucas, Charles E., Lum, Ying Wei, Lumati, Juliet Siena, Lyons, Gray R., MacGillivray, Thomas E., Magnuson, Thomas H., Mahdi, Elaa, Makary, Martin A., Malas, Mahmoud B., Mallon, William C., Manahan, Michele Ann, Manson, Paul N., Mansour, M. Ashraf, Mantilla, Nathalie, Manukyan, Mariuxi C., Markmann, James F., Maroun, Christopher A., Martin, Matthew J., Martin, Niels D., Martyak, Michael, Matar, Regina, Mathisen, Douglas J., Mathur, Aarti, Matsushima, Kazuhide, Mawn, J. Greg, McCarthy, Mary C., McCarthy, Patrick M., McDermott, Katherine, McFadden, David W., McGuire, Sean P., McHenry, Christopher R., McIntosh, Erin E., Melton-Meaux, Genevieve B., Meneshian, Avedis, Menon, Raman, Metkus Jr, Thomas S., Michelassi, Fabrizio, Mony, Shruti, Morgan, Katherine A., Morgan, Ryan B., Morris, Carol D., Morse, Christopher R., Muniappan, Ashok, II, Peter Muscarella, Mutch, Matthew, Muñoz-Largacha, Juan A., Nam, Arthur J., Narang, Amol Kumar, Nasr, Isam W., Nawalaniec, James T., Nehs, Matthew A., Nelson, Adam, Nettles, Brenda S., Newman, Lisa Ann, Nezami, Nariman, Nguyen, Dennis C., Nguyen, Hien T., Nicholson, Jake A., Nizam, Wasay, Novitsky, Yuri W., Oelschlager, Brant K., Ogilvie, Jennifer B., Jr., John A. Olson, Olson, Kristofor A., O’Mara, Charles S., Oseni, Tawakalitu O., Osgood, Greg M., Ostrosky-Zeichner, Luis, Ottmann, Shane, Pappas, Theodore N., Paranjape, Charudutt, Park, Adrian E., Park, Pauline K., Pastoriza, Jessica M., Patel, Purvi P., Patel, Shirali T., Patti, Marco G., Pawlik, Timothy M., Pearl, Gregory J., Jr., Walter Pegoli, Perler, Bruce A., Perrier, Nancy D., Philosophe, Benjamin, Pitt, Henry A., Plichta, Jennifer K., Podolsky, Dina, Politano, Amani D., Port, Elisa, Postol, Carolyn R., Prabhu, Ajita S., Preiss, Joshua E., Prescott, Jason D., Price, Leigh Ann, Price, Matthew D., Prushik, Scott G., Pugh, Carla M., Qaqish, T. Robert, Qasim, Zaffer, Quick, Jacob A., Radisic, Amanda, Radomski, Shannon N., Rasmussen, Todd E., Reddy, Abhinav V., Reed, Christopher R., Regelsberger-Alvarez, Christina Maria, Reifsnyder, Thomas, Reilly, Linda M., Riall, Taylor S., Ricci, John Peter, Robles, Anamaria J., Rodgers, Douglas, Roginsky, Alexandra B., Rojas-Khalil, Yesenia, Rokosh, Rae S., Rosati, Riccardo, Rose, J. Bart, Rosenberger, Laura H., Ross, Robert C., Rosson, Gedge D., Roy, Rishi A., Rozycki, Grace S., Ryan, Colleen M., Sachdeva, Uma M., Sacks, Bethany C., Sacks, Justin M., Sahli, Zeyad T., Sakran, Joseph V., Sanders, David, Sarr, Michael G., Sawyer, Robert G., Sbayi, Samer, Scalea, Thomas M., Schauer, Philip R., Scheurlen, Katharina M., Schimpf, Dennis K., Schlachter, Todd R., Schonefeld, Sally, Schulick, Andrew, Schulick, Richard D., Schweitzer, Michael A., Sell, Naomi M., Senagore, Anthony J., Shah, Aamir S., Shah, Adil A., Shames, Brian D., Sharma, Ashwyn K., Sheridan, Robert, Shirali, Aditya S., Shmelev, Artem, Shoham, Shmuel, Shores, Jaimie T., Sicklick, Jason K., Sieber, Frederick, Simmons, Justin M., Sims, Sarah S., Singh, Vikesh K., Smeds, Matthew R., Nikolhaus Smith, John, Smith, Thomas J., Jr., Thomas W. 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Published
2023
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50. Association between Age and Patient-Reported Changes in Voice and Swallowing after Thyroidectomy

Author

Sahli, Zeyad, Canner, Joseph K, Najjar, Omar, Schneider, Eric B., Prescott, Jason D., Russell, Jonathon O, Tufano, Ralph P., Zeiger, Martha A., and Mathur, Aarti

Subjects
Adult, Aged, 80 and over, Male, Voice Disorders, Adolescent, Frailty, Age Factors, Middle Aged, Article, Deglutition, Young Adult, Postoperative Complications, Treatment Outcome, Thyroidectomy, Voice, Humans, Female, sense organs, Patient Reported Outcome Measures, Postoperative Period, skin and connective tissue diseases, Child, Deglutition Disorders, Aged, Retrospective Studies
Abstract

BACKGROUND: Despite intact recurrent laryngeal nerves, patient-reported voice and swallowing changes are common after thyroidectomy. The association between patient age or frailty status and these changes is unknown. The aim of this study was to evaluate the impact of age and frailty on the incidence of voice and swallowing alterations after thyroidectomy. MATERIALS & METHODS: We performed an IRB-approved retrospective review of consecutive patients who underwent total thyroidectomy with intraoperative recurrent laryngeal nerve (RLN) monitoring at a single institution between January 2014 and September 2016. Patients with RLN injury were excluded. After data extraction, a modified frailty index (mFI) was calculated for each patient. The association among risk factors, including age, mFI, prior history of neck surgery, frequent voice use, presence of malignancy or gastroesophageal reflux disease, and smoking status and reported voice and/or swallowing changes was examined. RESULTS: Of 924 patients undergoing thyroidectomy, 148 (16.0%) reported only changes in voice, 52 (5.6%) only difficulty in swallowing, and 26 (2.8%) patients reported changes with both voice and swallowing. On multivariate analysis, we found a significant increase in voice or swallowing alterations up to the age of 50 (5% increased odds per year) after which these changes plateaued. We found that mFI was not associated with voice or swallowing changes. CONCLUSIONS: Age ≥ 50 is independently associated with development of voice or swallowing changes after thyroidectomy despite intact RLN. Additional prospective studies are needed to validate these findings, further define this association, and identify risk factors for developing these changes. EVIDENCE LEVEL: Individual retrospective cohort study (2b)

Published
2018

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