[PP.25.14] RECURRENCE OR NEW TUMOURS AFTER COMPLETE RESECTION OF PHAEOCHROMOCYTOMAS AND PARAGANGLIOMAS: A SYSTEMATIC REVIEW AND META-ANALYSIS. (September 2016)

• Record Type: Journal Article
• Authors: Amar, L.; Lussey, C.; Lenders, J.W.M.; Pratt, J. Djadi; Plouin, P.-F.; Steichen, O.
• Is Part Of: Journal of hypertension. Volume 34:(2016) Supplement 2
• Publication Date: 2016-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000492123.70076.90
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: The risk of recurrent disease after resection of a phaeochromocytoma or paraganglioma dictates follow-up intensity and duration. Our goal was to systematically review the incidence and factors associated with recurrences or new tumours after complete resection. Design and method: Pubmed and Embase were searched from 1980 to 2011 for studies published in English on patients with: non-metastatic phaeochromocytomas and thoraco-abdomino-pelvic paragangliomas; complete tumour resection; postoperative follow-up exceeding 1 month; recurrence or new tumour documented by pathology, hypersecretion and/or imaging tests. Clinical and methodological data were independently collected by two abstractors and reviewed by a third one. Incidence rates of new events after curative surgery were calculated for each study with sufficient information and pooled using random effect meta-analysis. Results: Thirty-eight studies were selected from 3518 references, 36 reporting retrospective cohorts from the USA, Europe and Asia. Patient follow-up was neither standardised nor exhaustive in included studies. A clear description of patient retrieval methods was available for 9 studies, follow-up protocol and patient flow for 4 studies. Only two studies used multivariable methods to assess potential predictors of postoperative events. The overall rate of recurrent disease was 0.98 events/100 person-years (95% confidence interval 0.71, 1.25) according to random effect meta-analysis of data from 34 studies. The time pattern of new event risk was not assessed and data was scarce after the first 10 years of follow-up. Syndromic diseases and paragangliomas were consistently associated with a higher risk of new event in individual studies and in meta-regression analysis. However, the power of risk factor analysis within and across studies was very limited. Conclusions: The risk of recurrent disease after complete resection of phaeochromocytoma may be lower than usually thought, although late events occur. Risk stratification is required to tailor the follow-up protocol after complete resection of a phaeochromocytoma or paraganglioma. Large multicentric studies are needed to this end.