Key result
Adjuvant mitotane is linked to a ~38% lower recurrence risk after adrenocortical carcinoma resection.
Why the study?
The adjuvant use of mitotane after resection of adrenocortical carcinoma without distant metastasis has been controversial and its prognostic benefits were unclear.
Does adjuvant mitotane improve recurrence-free survival and overall survival in patients who underwent resection of adrenocortical carcinoma without distant metastasis?
Meta-Analysis (n=1,249)
Does adjuvant mitotane improve recurrence-free survival and overall survival in patients who underwent resection of adrenocortical carcinoma without distant metastasis?
Adjuvant mitotane significantly decreases the recurrence rate and mortality after resection of adrenocortical carcinoma in patients without distant metastasis.
May support adjuvant mitotane after ACC resection; extends meta-analytic data but leaves optimal use and OS open pending RCTs.
BACKGROUND: The adjuvant use of mitotane on adrenocortical carcinoma (ACC) has always been in controversy. We aimed to assess the prognostic benefits of adjuvant mitotane after resection of ACC in patients without distant metastasis. METHODS: The PubMed, WoS, Embase, and Cochrane Library databases were systematically searched. Recurrence-free survival (RFS) and overall survival (OS) were adopted as measurements. A meta-analysis was conducted based on hazard ratio (HR) with 95% confidence interval (CI). A study was included only if the enrolled patients underwent resection of ACC without adjuvant chemotherapy except mitotane. RESULTS: A total of 5 retrospective studies reporting on 1249 patients were included for this meta-analysis. The meta-analysis showed that adjuvant mitotane was significantly associated with prolonged RFS (HR = 0.62; 95%CI, 0.42-0.94; P < 0.05) and prolonged OS (HR = 0.69; 95%CI, 0.55-0.88, P < 0.05). CONCLUSION: After comprehensive review, current evidence suggests that adjuvant mitotane significantly decreases the recurrence rate and mortality after resection of ACC in patients without distant metastasis, but these findings need further demonstration from prospective controlled trials.
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Tang et al. (2018) conducted a meta-analysis in Adrenocortical carcinoma (n=1,249). Adjuvant mitotane vs. No adjuvant mitotane was evaluated on Recurrence-free survival (RFS) (HR 0.62, 95% CI 0.42-0.94, p=<0.05). Adjuvant mitotane was significantly associated with prolonged recurrence-free survival (HR 0.62; 95% CI 0.42-0.94; P<0.05) after resection of adrenocortical carcinoma.
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