Influence of hormonal functional status on survival in adrenocortical carcinoma: systematic review and meta-analysis

in European Journal of Endocrinology
Correspondence should be addressed to O M Dekkers; Email: o.m.dekkers@lumc.nl
Restricted access

Objective

Adrenocortical carcinoma (ACC) is a malignancy with a poor prognosis. Many publications in ACC report on risk factors for a poor outcome; one risk factor studied is hormonal hypersecretion (cortisol, sex-hormones, steroid precursors or aldosterone). The aim of this systematic review was to study the association between hormonal secretion and recurrence or mortality in ACC.

Design

Systematic review and meta-analysis. We searched PubMed, EMBASE and The Cochrane library (January 2018) for cohort studies examining the association between hormonal secretion on overall or recurrence-free survival in ACC.

Methods

A random-effects model meta-analysis was performed to obtain a weighted relative risk comparing cortisol-secreting and/or androgen-secreting ACCs to non-secreting tumours regarding overall and recurrence-free survival. Risk of bias assessment was performed for all studies included.

Results

Nineteen publications were included representing a total of 3814 patients. Most studies were generally considered low/intermediate risk of bias. Meta-analysis showed higher mortality risk for cortisol-secreting ACCs, weighted relative risk 1.71 (95% CI: 1.18–2.47) combining studies that adjusted for tumour stage; also a higher recurrence risk was found for cortisol producing ACCs, relative risk 1.43 (95% CI: 1.18–1.73). Androgen secretion was not clearly associated with survival (RR: 0.82, 95% CI: 0.60–1.12).

Conclusion

This systematic review and meta-analysis show that cortisol-secreting ACCs are associated with a worse overall survival; future research is needed to establish whether this association points to negative effects of cortisol action, whether it signifies a more aggressive ACC subtype or whether cortisol is merely a prognostic marker.

Downloadable materials

  • Appendix 1: Pubmed/Embase/Cochrane search
  • Appendix 2: Study characteristics of included publications
  • Appendix 3: Risk of bias assessment of individual publication. The colours represent the following: green = low risk of bias; orange = intermediate risk of bias; red = high risk of bias. Numbers correspond to numbers of the articles in appendix 2.
  • Appendix 4: Funnel plot of publications on mortality in cortisol secreting ACCs
  • Appendix 5: Funnel plot of publications on mortality in functional ACCs
  • Appendix 6: Relative risk of functional ACC for overall survival
  • Appendix 7: relative risk of functional ACC for recurrence-free survival
  • Appendix 8: Relative risk of androgen secretion for overall survival
  • Appendix 9: Meta-regression analysis

 

     European Society of Endocrinology

Article Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 515 515 168
Full Text Views 421 421 18
PDF Downloads 97 97 7

Altmetrics

Related Articles

Figures

  • View in gallery

    Search strategy.

  • View in gallery

    Weighted relative risks of hormone-secreting ACCs for overall survival.

  • View in gallery

    Weighted relative risk of cortisol-secreting ACCs for overall survival.

  • View in gallery

    Weighted relative risk of cortisol-secreting ACCs for recurrence-free survival.

PubMed

Google Scholar