Inflammation-based scores in a large cohort of adrenocortical carcinoma and adrenocortical adenoma: role of the hormonal secretion pattern

Alessandra Mangone, Vittoria Favero, Alessandro Prete, Yasir Elhassan, Miriam Asia, Rowan Hardy, Giovanna Mantovani, Iacopo Chiodini, Cristina Ronchi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

BACKGROUND: Serum inflammation-based scores can predict clinical outcome in several cancer types, including adrenocortical carcinoma (ACC). It is unclear whether the extent of inflammation-based scores alterations in ACC reflects malignancy, steroid excess, or both.

METHODS: We investigated a large retrospective cohort of adrenocortical adenomas (ACA, n=429) and ACC (n=61) with available baseline full blood count and hormonal evaluation. We examined the relationship between different inflammation-based scores [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and prognostic nutrition index (PNI)], malignancy and steroid secretion patterns.

RESULTS: All inflammation-based scores differed between ACC and ACA: patients with ACC had higher NLR, PLR, SII and lower LMR and PNI levels compared to ACA (all p values <0.001). NLR showed a positive correlation with cortisol levels after overnight 1mg-dexamethasone suppression test (1mg-DST), both in ACC and ACA (p<0.01). The ROC curve analysis determined NLR>2.6 as the best cut-off to discriminate ACC from ACA [AUC=0.846, p<0.01]. At multivariable analysis, NLR>2.6 was independently associated with ACC, 1mg-DST cortisol levels and age, but not with tumour size. Considering ACC, NLR and SII were higher and PNI was lower in patients with cortisol excess compared to those without cortisol excess (p=0.002, p=0.007, and p=0.044 respectively). Finally, LMR and NLR differed significantly between inactive-ACC (n=10) and inactive-ACA (n=215) (p=0.040 and p=0.031, respectively).

CONCLUSION: Inflammation-based scores are related to steroid secretion both in ACC and ACA. ACCs present a higher grade of inflammation regardless of their secretion, likely as a feature of malignancy itself.
Original languageEnglish
Number of pages10
JournalJournal of endocrinological investigation
Early online date4 Jul 2024
DOIs
Publication statusE-pub ahead of print - 4 Jul 2024

Keywords

  • Adrenocortical tumors
  • Inflammation scores
  • Cushing’s syndrome
  • Adrenal cancer
  • Neutrophil–lymphocyte-ratio

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