Benign disease
Surgery is a curative treatment in more than 85% of cases.[67]Cryer PE. Diseases of the sympathochromaffin system. In: Felig P, Frohman LA, eds. Endocrinology and metabolism, 4th ed. New York: McGraw-Hill; 2001:525-51. There is a 95% 5-year survival with benign disease with recurrence in <10%.[68]Fung MM, Viveros OH, O'Connor DT. Diseases of the adrenal medulla. Acta Physiol (Oxf). 2008 Feb;192(2):325-35.
http://www.ncbi.nlm.nih.gov/pubmed/18021328?tool=bestpractice.com
Recurrences may be benign or malignant. At least 10 years of follow-up are recommended after removal of a phaeochromocytoma.[93]Huang KH, Chung SD, Chen SC, et al. Clinical and pathological data of 10 malignant pheochromocytomas: long-term follow up in a single institution. Int J Urol. 2007 Mar;14(3):181-5.
http://www.ncbi.nlm.nih.gov/pubmed/17430251?tool=bestpractice.com
Hereditary tumours are more likely to recur and, therefore, require long-term follow-up. In benign disease, however, there is still a considerable risk of morbidity and mortality secondary to complications associated with hypercatecholaminaemia. Up to 20% of patients who have surgical resection for benign disease retain some degree of hypertension and follow-up for long-term blood pressure management is necessary.[68]Fung MM, Viveros OH, O'Connor DT. Diseases of the adrenal medulla. Acta Physiol (Oxf). 2008 Feb;192(2):325-35.
http://www.ncbi.nlm.nih.gov/pubmed/18021328?tool=bestpractice.com
Metastatic disease
There are no curative treatments for metastatic disease, which has a 5-year survival of 42%.[94]Hamidi O, Young WF Jr, Gruber L, et al. Outcomes of patients with metastatic phaeochromocytoma and paraganglioma: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2017 Nov;87(5):440-50.
http://www.ncbi.nlm.nih.gov/pubmed/28746746?tool=bestpractice.com
Metastatic disease is, however, unpredictable, with reports of patients with metastatic disease surviving over 20 years after diagnosis.[95]Yoshida S, Hatori M, Noshiro T, et al. Twenty-six-years' survival with multiple bone metastasis of malignant pheochromocytoma. Arch Orthop Trauma Surg. 2001 Nov;121(10):598-600.
http://www.ncbi.nlm.nih.gov/pubmed/11768644?tool=bestpractice.com
Factors that are thought to prolong survival include younger age, female sex, early diagnosis, and complete excision of the primary tumour.[96]Mei L, Khurana A, Al-Juhaishi T, et al. Prognostic factors of malignant pheochromocytoma and paraganglioma: a combined SEER and TCGA databases review. Horm Metab Res. 2019 Jul;51(7):451-7.
http://www.ncbi.nlm.nih.gov/pubmed/30919391?tool=bestpractice.com
Male sex and synchronous metastases were associated with increased mortality risk.[94]Hamidi O, Young WF Jr, Gruber L, et al. Outcomes of patients with metastatic phaeochromocytoma and paraganglioma: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2017 Nov;87(5):440-50.
http://www.ncbi.nlm.nih.gov/pubmed/28746746?tool=bestpractice.com
Tumour mutational status can be used as prognostic biomarkers.[20]Jhawar S, Arakawa Y, Kumar S, et al. New insights on the genetics of pheochromocytoma and paraganglioma and its clinical implications. Cancers (Basel). 2022 Jan 25;14(3):594.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8833412
http://www.ncbi.nlm.nih.gov/pubmed/35158861?tool=bestpractice.com
Tumour mutations in succinate dehydrogenase (SDH) gene subunits are often multiple, aggressive, metastatic, and have a poorer prognosis.[97]Nölting S, Ullrich M, Pietzsch J, et al. Current management of pheochromocytoma/paraganglioma: a guide for the practicing clinician in the era of precision medicine. Cancers (Basel). 2019 Oct 8;11(10):1505.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827093
http://www.ncbi.nlm.nih.gov/pubmed/31597347?tool=bestpractice.com