{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T10:50:07Z","timestamp":1773312607784,"version":"3.50.1"},"reference-count":0,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[1998,6,1]],"date-time":"1998-06-01T00:00:00Z","timestamp":896659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[1998,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. It has been difficult to establish a strict treatment program for ACC, and better treatment alternatives and diagnostic tools must be sought. Even though surgery is the treatment of choice, the role of surgery in advanced disease has been questioned. Eighteen consecutive patients were treated at our unit over a 22\u2010year period (1975\u20131997). All patients underwent surgery and were followed by our protocol, which includes urinary steroid profiles, clinical examinations, analysis of steroid hormones, and radiologic investigations. Twelve patients received mitotane with drug concentration measurements to deliver an effective, nontoxic dose. The median duration of mitotane treatment was 12\u00a0months. Few side effects were observed. Four patients with low\u2010stage tumors underwent second\u2010look operations with no pathologic findings. Five patients were subjected to repeat operations, and the mean duration of the disease\u2010free interval before repeat surgery for these patients was 59\u00a0months. There was a significant positive correlation between the disease\u2010free interval and the observed survival after repeat surgery. Eleven patients with intentionally curative surgery had their urinary steroid profiles tested several times postoperatively. For five patients preoperative urine samples were also available. Steroid profiles indicated recurrent disease despite normal radiologic findings in two of these five patients. The follow\u2010up ranged from 6 weeks to 24 years. The predicted 5\u2010year survival was 58% according to the Kaplan\u2010Meier method. We conclude that monitoring serum concentrations of mitotane makes long\u2010term treatment possible with few side effects; steroid profile analysis can be used for early detection of tumor recurrence; and repeat surgery for recurrence is of value for patients with long disease\u2010free intervals.<\/jats:p>","DOI":"10.1007\/s002689900442","type":"journal-article","created":{"date-parts":[[2002,8,25]],"date-time":"2002-08-25T05:57:49Z","timestamp":1030255069000},"page":"605-612","source":"Crossref","is-referenced-by-count":50,"title":["Adrenocortical Carcinoma: Surgery and Mitotane for Treatment and Steroid Profiles for Follow\u2010up"],"prefix":"10.1002","volume":"22","author":[{"given":"A.","family":"Khorram\u2010Manesh","sequence":"first","affiliation":[{"name":"Department of Surgery Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Ahlman","sequence":"additional","affiliation":[{"name":"Department of Surgery Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Jansson","sequence":"additional","affiliation":[{"name":"Department of Surgery Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"W\u00e4ngberg","sequence":"additional","affiliation":[{"name":"Department of Surgery Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Pathology Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.E.","family":"Jakobsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Eliasson","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Lindstedt","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.E.","family":"Tisell","sequence":"additional","affiliation":[{"name":"Department of Surgery Sahlgrenska University Hospital S\u2010413 45 G\u00f6teborg Sweden<!--<country1>SE<\/country1>-->"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[1998,6]]},"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s002689900442.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s002689900442\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s002689900442","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T16:51:00Z","timestamp":1704991860000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s002689900442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1998,6]]},"references-count":0,"journal-issue":{"issue":"6","published-print":{"date-parts":[[1998,6]]}},"alternative-id":["10.1007\/s002689900442"],"URL":"https:\/\/doi.org\/10.1007\/s002689900442","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[1998,6]]}}}