Abstract
Adrenocortical carcinoma (ACC) is a rare aggressive cancer with heterogeneous behaviour. Disease surveillance relies on frequent imaging, which comes with significant radiation exposure. The aim of the study was to investigate the role of circulating cell-free DNA (ccfDNA)-related biomarkers (BM) for prognostication and monitoring of ACC.
We investigated 34 patients with ACC and 23 healthy subjects (HS) as controls. ccfDNA was extracted by commercial kits and ccfDNA concentrations quantified by fluorimeter (BM1). Targeted sequencing was performed using a customised panel of 27 ACC-specific genes. Leucocyte DNA was used to discriminate somatic variants (BM2), while tumour DNA was sequenced in 22/34 cases for comparison. Serial ccfDNA samples were collected during follow-up in 19 ACC patients (median period 9 months) and analysed in relationship with standard radiological imaging.
ccfDNA concentrations were higher in ACC than HS (mean±SD, 1.15±1.56 vs 0.05±0.05 ng/µl, P<0.0001), 96% of them being above the cut-off of 0.146 ng/µl (mean HS+2SD, positive BM1). At ccfDNA sequencing, 47% of ACC showed at least one somatic mutation (positive BM2). A combined ccfDNA-BM score was strongly associated with both progression-free and overall survival (HR=2.63, 95%CI=1.13-6.13, P=0.010, and HR=5.98, 95%CI=2.29-15.6, P=0.0001, respectively). During disease monitoring, positive BM2 showed the best specificity (100%) and sensitivity (67%) to detect ACC recurrence or progress compared to BM1.
In conclusion, ccfDNA-related BMs are frequently detected in ACC patients and represent a promising, minimally invasive tool to predict clinical outcome and complement surveillance imaging. Our findings will be validated in a larger cohort of ACCs with long-term follow-up.
We investigated 34 patients with ACC and 23 healthy subjects (HS) as controls. ccfDNA was extracted by commercial kits and ccfDNA concentrations quantified by fluorimeter (BM1). Targeted sequencing was performed using a customised panel of 27 ACC-specific genes. Leucocyte DNA was used to discriminate somatic variants (BM2), while tumour DNA was sequenced in 22/34 cases for comparison. Serial ccfDNA samples were collected during follow-up in 19 ACC patients (median period 9 months) and analysed in relationship with standard radiological imaging.
ccfDNA concentrations were higher in ACC than HS (mean±SD, 1.15±1.56 vs 0.05±0.05 ng/µl, P<0.0001), 96% of them being above the cut-off of 0.146 ng/µl (mean HS+2SD, positive BM1). At ccfDNA sequencing, 47% of ACC showed at least one somatic mutation (positive BM2). A combined ccfDNA-BM score was strongly associated with both progression-free and overall survival (HR=2.63, 95%CI=1.13-6.13, P=0.010, and HR=5.98, 95%CI=2.29-15.6, P=0.0001, respectively). During disease monitoring, positive BM2 showed the best specificity (100%) and sensitivity (67%) to detect ACC recurrence or progress compared to BM1.
In conclusion, ccfDNA-related BMs are frequently detected in ACC patients and represent a promising, minimally invasive tool to predict clinical outcome and complement surveillance imaging. Our findings will be validated in a larger cohort of ACCs with long-term follow-up.
Original language | English |
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Article number | lvae022 |
Pages (from-to) | 234-247 |
Number of pages | 14 |
Journal | European Journal of Endocrinology |
Volume | 190 |
Issue number | 3 |
Early online date | 7 Mar 2024 |
DOIs | |
Publication status | E-pub ahead of print - 7 Mar 2024 |
Bibliographical note
Financial support:This work has been supported by the Deutsche Krebshilfe (70113526 M.F., C.L.R, and S.A.), the AMEND (ACC Research Award 2019 and 2021 to C.L.R.), and the European Reference Network on Rare Endocrine Conditions (Endo-ERN). A.P. receives support from the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham (grant reference number NIHR203326), while C.L.R receives support from HRA Pharma Rare Disease (research grant). The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care UK.
Keywords
- ccfDNA
- adrenal cancer
- personalised medicine