{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T03:35:09Z","timestamp":1774496109995,"version":"3.50.1"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T00:00:00Z","timestamp":1647302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Scientific Research Foundation of Zhejiang Province","award":["2018KY019"],"award-info":[{"award-number":["2018KY019"]}]},{"name":"Medical Scientific Research Foundation of Zhejiang Province","award":["2021KY449"],"award-info":[{"award-number":["2021KY449"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The present existing data on the association of metastatic sites and prognosis of patients with metastatic adrenal malignancy are limited. This study aims to investigate the impact of different distant metastases pattern on the survival of patients with adrenal malignancy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A dataset from the National Cancer Institute\u2019s Surveillance, Epidemiology, and End Results (SEER) 18 Registries (2000\u20132017) was selected for a retrospective metastatic adrenal malignancy cohort study. There was information on distribution of metastatic lesions in bone, brain, liver, and lung in the SEER database. Kaplan-Meier analysis and nomogram analyses were applied to compare the survival distribution of cases. Univariate and multivariate cox regression models were used to analyze survival outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>From the SEER database, a total of 980 patients with primary metastatic adrenal malignancy from 2010 to 2017 were enrolled in this cohort study. Based on the initial metastatic sites, 42.3%, 38.4%, 30.5%, and 4.9% of patients were found bone, liver, lung, and brain metastasis, respectively. Patients who had a single site of distant metastases accounted for 52.6% (515\/980) and had a better overall survival (OS) and cancer-specific survival (CSS) (both P &lt; 0.001). In contrast with the tumor arising from the cortex, the tumor from the medulla showed better survival outcomes in both OS and CSS (P &lt; 0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Different histological types possess various metastatic features and prognostic values. Understanding these differences may contribute to designing targeted pre-treatment assessment of primary metastatic adrenal malignancy and creating a personalized curative intervention.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0264431","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T17:25:42Z","timestamp":1647365142000},"page":"e0264431","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["The prognosis of different distant metastases pattern in malignant tumors of the adrenal glands: A population-based retrospective study"],"prefix":"10.1371","volume":"17","author":[{"given":"Jia","family":"Miao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haibin","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianxin","family":"Cui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zujie","family":"Mao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4397-8239","authenticated-orcid":true,"given":"Dahong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,3,15]]},"reference":[{"issue":"suppl 1","key":"pone.0264431.ref001","doi-asserted-by":"crossref","first-page":"e756s","DOI":"10.6061\/clinics\/2018\/e756s","article-title":"Primary malignant tumors of the adrenal glands","volume":"73","author":"MQ Almeida","year":"2018","journal-title":"Clinics (Sao Paulo)"},{"issue":"7","key":"pone.0264431.ref002","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1002\/cncr.31916","article-title":"The who, when, and why of primary adrenal malignancies: Insights into the epidemiology of a rare clinical entity","volume":"125","author":"T Chandrasekar","year":"2019","journal-title":"Cancer"},{"issue":"12","key":"pone.0264431.ref003","doi-asserted-by":"crossref","first-page":"4551","DOI":"10.1210\/jc.2013-3020","article-title":"Update in adrenocortical carcinoma","volume":"98","author":"M Fassnacht","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"pone.0264431.ref004","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1007\/s00268-015-3283-2","article-title":"Does Lymphadenectomy Improve Survival in Patients with Adrenocortical Carcinoma? A Population-Based Study","volume":"40","author":"N Nilubol","year":"2016","journal-title":"World J Surg"},{"issue":"4","key":"pone.0264431.ref005","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.path.2015.07.005","article-title":"Adrenal Tumors in Adults","volume":"8","author":"A Pinto","year":"2015","journal-title":"Surg Pathol Clin"},{"issue":"3","key":"pone.0264431.ref006","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.euf.2015.12.006","article-title":"Management of the Incidental Adrenal Mass","volume":"1","author":"AZ Thomas","year":"2016","journal-title":"European urology focus"},{"issue":"4","key":"pone.0264431.ref007","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S1470-2045(15)70081-1","article-title":"Linsitinib (OSI-906) versus placebo for patients with locally advanced or metastatic adrenocortical carcinoma: a double-blind, randomised, phase 3 study","volume":"16","author":"M Fassnacht","year":"2015","journal-title":"Lancet Oncol"},{"issue":"11","key":"pone.0264431.ref008","doi-asserted-by":"crossref","first-page":"3324","DOI":"10.1245\/s10434-018-6657-5","article-title":"Unusual Techniques for Preserving Surgical and Oncologic Safety in Hepatectomy of Advanced Adrenal Malignancy with Vena Cava and Liver Invasion","volume":"25","author":"JM Lee","year":"2018","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"pone.0264431.ref009","doi-asserted-by":"crossref","first-page":"4172","DOI":"10.1038\/s41467-018-06366-z","article-title":"Metastatic adrenocortical carcinoma displays higher mutation rate and tumor heterogeneity than primary tumors","volume":"9","author":"SK Gara","year":"2018","journal-title":"Nat Commun"},{"issue":"5","key":"pone.0264431.ref010","first-page":"6915","article-title":"Association of tumor size with metastatic potential and survival in patients with adrenocortical carcinoma: an analysis of the National Cancer Database","volume":"20","author":"DJ Canter","year":"2013","journal-title":"Can J Urol"},{"issue":"6","key":"pone.0264431.ref011","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s40272-017-0251-3","article-title":"Incidence, Survival, and Treatment of Localized and Metastatic Neuroblastoma in Germany 1979\u20132015","volume":"19","author":"F Berthold","year":"2017","journal-title":"Paediatr Drugs"},{"issue":"4","key":"pone.0264431.ref012","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4","article-title":"Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","volume":"15","author":"FE Harrell","year":"1996","journal-title":"Stat Med"},{"issue":"13","key":"pone.0264431.ref013","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1002\/sim.1802","article-title":"Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation","volume":"23","author":"MJ Pencina","year":"2004","journal-title":"Stat Med"},{"issue":"3","key":"pone.0264431.ref014","doi-asserted-by":"crossref","first-page":"531","DOI":"10.2214\/ajr.148.3.531","article-title":"Primary adrenocortical carcinoma: CT evaluation with clinical correlation","volume":"148","author":"EK Fishman","year":"1987","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"pone.0264431.ref015","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0467","article-title":"Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors","volume":"175","author":"M Fassnacht","year":"2016","journal-title":"Eur J Endocrinol"},{"issue":"4","key":"pone.0264431.ref016","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1002\/(SICI)1097-0142(20000215)88:4<711::AID-CNCR1>3.0.CO;2-W","article-title":"Adrenocortical carcinoma: clinical and laboratory observations","volume":"88","author":"BL Wajchenberg","year":"2000","journal-title":"Cancer"},{"issue":"6","key":"pone.0264431.ref017","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1038\/nrendo.2010.235","article-title":"Adrenocortical carcinoma: a clinician\u2019s update","volume":"7","author":"M Fassnacht","year":"2011","journal-title":"Nat Rev Endocrinol"},{"issue":"6","key":"pone.0264431.ref018","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.surg.2006.07.035","article-title":"Outcomes of adrenal cortical carcinoma in the United States","volume":"140","author":"BL Paton","year":"2006","journal-title":"Surgery"},{"issue":"42","key":"pone.0264431.ref019","doi-asserted-by":"crossref","first-page":"44955","DOI":"10.18632\/oncotarget.5831","article-title":"Conditional survival among patients with adrenal cortical carcinoma determined using a national population-based surveillance, epidemiology, and end results registry","volume":"6","author":"WJ Xiao","year":"2015","journal-title":"Oncotarget"},{"issue":"6","key":"pone.0264431.ref020","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1530\/EJE-13-0519","article-title":"Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a tertiary care center","volume":"169","author":"M Ayala-Ramirez","year":"2013","journal-title":"Eur J Endocrinol"},{"issue":"4","key":"pone.0264431.ref021","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/BF03351068","article-title":"Adrenal tumors: how to establish malignancy?","volume":"27","author":"M Fassnacht","year":"2004","journal-title":"J Endocrinol Invest"},{"issue":"17","key":"pone.0264431.ref022","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1056\/NEJM199004263221705","article-title":"Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy","volume":"322","author":"JP Luton","year":"1990","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0264431.ref023","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1200\/JCO.2004.08.085","article-title":"Clinical and outcome characteristics of children with adrenocortical tumors: a report from the International Pediatric Adrenocortical Tumor Registry","volume":"22","author":"E Michalkiewicz","year":"2004","journal-title":"J Clin Oncol"},{"issue":"8","key":"pone.0264431.ref024","doi-asserted-by":"crossref","first-page":"636","DOI":"10.14740\/jocmr3503w","article-title":"The Characteristics and Trends in Adrenocortical Carcinoma: A United States Population Based Study","volume":"10","author":"E Sharma","year":"2018","journal-title":"J Clin Med Res"},{"key":"pone.0264431.ref025","doi-asserted-by":"crossref","first-page":"5311","DOI":"10.2147\/OTT.S147352","article-title":"Primary site surgery for metastatic adrenocortical carcinoma improves survival outcomes: an analysis of a population-based database","volume":"10","author":"S Wang","year":"2017","journal-title":"Onco Targets Ther"},{"issue":"17","key":"pone.0264431.ref026","doi-asserted-by":"crossref","first-page":"e6741","DOI":"10.1097\/MD.0000000000006741","article-title":"The efficacy of radiation therapy in adrenocortical carcinoma: A propensity score analysis of a population-based study","volume":"96","author":"Y Luo","year":"2017","journal-title":"Medicine (Baltimore)"},{"issue":"5","key":"pone.0264431.ref027","first-page":"1750","article-title":"Adrenomedullin in human brain, adrenal glands and tumor tissues of pheochromocytoma, ganglioneuroblastoma and neuroblastoma","volume":"80","author":"F Satoh","year":"1995","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"pone.0264431.ref028","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1677\/joe.0.1540027","article-title":"Cerebellin and cerebellin mRNA in the human brain, adrenal glands and the tumour tissues of adrenal tumour, ganglioneuroblastoma and neuroblastoma","volume":"154","author":"F Satoh","year":"1997","journal-title":"J Endocrinol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264431","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T17:26:46Z","timestamp":1647365206000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264431"}},"subtitle":[],"editor":[{"given":"Filomena","family":"de Nigris","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,15]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0264431","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,15]]}}}