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5th International ACC Symposium: Surgical Considerations in the Treatment of Adrenocortical Carcinoma: 5th International ACC Symposium Session: Who, When and What Combination?

ABSTRACT: Significant progress has been made in the understanding of how surgical technique impacts outcome in patients with adrenal cancer. Current and future areas of investigation center on expanding the role of surgery in patients with locally recurrent or metastatic disease, use of neoadjuvant therapy as a bridge to surgery, the impact of formal lymphadenectomy on survival, and improved diagnosis, prognosis, and selection of patients for surgery and other treatments using morphomic analysis.

SUBMITTER: Miller BS

PROVIDER: S-EPMC10355910 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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5th International ACC Symposium: Surgical Considerations in the Treatment of Adrenocortical Carcinoma: 5th International ACC Symposium Session: Who, When and What Combination?

Miller Barbra S BS

Hormones & cancer 20160104 1

Significant progress has been made in the understanding of how surgical technique impacts outcome in patients with adrenal cancer. Current and future areas of investigation center on expanding the role of surgery in patients with locally recurrent or metastatic disease, use of neoadjuvant therapy as a bridge to surgery, the impact of formal lymphadenectomy on survival, and improved diagnosis, prognosis, and selection of patients for surgery and other treatments using morphomic analysis. ...[more]

PMID: 26728469

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Project description:Adrenocortical carcinoma (ACC) is a rare endocrine malignancy accounting for between 0.02 and 0.2 percent of all cancer deaths. Surgical removal offers the only current potential for cure. Unfortunately, ACC has undergone metastatic spread in approximately 40-70 percent of patients at the time of diagnosis. Standard chemotherapy with mitotane containing regimens is often ineffective and associated with intolerable side-effects. Modern molecular technologies now allow the examination of germ-line and somatic DNA for chromosomal alterations which can give biological insight into cancer processes. Using an array-based high density comparative genomic hybridization (CGH) screen, genomic aberrations within 25 ACC patients were assessed to identify genomic characteristic of this cancer. Genomes were queried with >44,000 probes on the Agilent Human Genome CGH array detecting regions of chromosomal gain and loss within the tumor population. Statistical analysis of this genetic landscape reveals a set of chromosomal aberrations strongly associated with survival in an accumulation dependent fashion. These regions may hold prognostic indicators and offer therapeutic targets that can be used to develop novel treatments for aggressive tumors. Experiment Overall Design: Array-based high density comparative genomic hybridization (CGH) screen was utilized to identify genomic aberrations within 25 ACC patients. Thirteen tumor samples are from male and 12 are from female patients. The mean age of patients is 51.8 years (range, 23.3-77.7 years) with a median of 54.2 years. The mean tumor physical measurements for the ACC set are a mean weight of 536.3 grams (range, 20.5-2880 grams) and size of 10.7 cm (range, 3-21.5 cm). The clinical data also includes functional status of the tumor which is based on clinical parameters and confirmed by biochemical analysis. Nonfunctional tumors or those that do not over-produce hormones represent 48% of the tumor set. The localization of each tumor is a measure of the tumor metastatic characteristic at time of operation while tumor grade is a histologically based rating system for tumor progression. Sixty percent of the tumors (15 of 25) were localized to the adrenal area with no indication of metastatic spread. The majority of tumors were grade 3 and 4 at time of diagnosis (17 of 25) indicating necrosis and atypical mitosis of >21/50 hpf. Genomes were queried with >44,000 probes on the Agilent Human Genome CGH array detecting regions of chromosomal gain and loss within the tumor population.

Project description:BackgroundSurgical peer coaching has been associated with high rates of practice change but remains largely unutilized. The purpose of this study was to survey surgeons internationally to investigate attitudes regarding peer coaching and to identify any international differences to inform the design of future coaching programs.MethodsPracticing surgeons in general surgery or related subspecialties were eligible to participate. Invitations to complete the survey were distributed through 13 surgical associations, social media, and personal e-mail invitations. Responses were obtained between June 1st and August 31st, 2020.ResultsA total of 521 surveys were collected. The majority of participants practiced in North America (263; 50%) with remaining respondents from Asia (81; 16%), Europe (34;7%), South America (21; 4%), Africa (17; 3%), and Oceania (6; 1%). Duration of practice was equally distributed across 4 intervals (0-5 years; 6-15 years; 16-25 years; > 25 years). Respondents most frequently identified as general surgeons (290; 67%) and 325 (75%) were male. Awareness of peer coaching was reported by 275 (53%) respondents, with 197 (44%) never seeking formal feedback from peers. The majority of respondents (372; 84%) would be willing to participate in a peer coaching program, with monthly interactions the most desirable frequency reported (193; 51%). Coaching in the operating room was preferred by most participants (360; 86%). Few respondents (67; 14%) would accept coaching from someone unknown to them. Participants identified key coaching program elements as: feedback kept private and confidential (267; 63%); opportunity to provide feedback to the coach (247; 59%); personalized goal setting (244; 58%); and the option to choose one's own coach (205; 49%). The most commonly cited potential barrier to participation was logistical constraints (334; 79%).ConclusionThis international survey of practicing surgeons demonstrated that peer feedback is rarely used in practice, but there is high interest and acceptance of the peer coaching model for continuous professional development. Findings regarding preferred program structure may be useful to inform the design of future peer coaching programs.

Dataset Information

5th International ACC Symposium: Surgical Considerations in the Treatment of Adrenocortical Carcinoma: 5th International ACC Symposium Session: Who, When and What Combination?

Publications

5th International ACC Symposium: Surgical Considerations in the Treatment of Adrenocortical Carcinoma: 5th International ACC Symposium Session: Who, When and What Combination?

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