TY - JOUR
T1 - Major prognostic role of Ki67 in localized adrenocortical carcinoma after complete resection
AU - Beuschlein, F
AU - Weigel, Jens
AU - Saeger, W
AU - Kroiss, M
AU - Wild, V
AU - Daffara, F
AU - Libé, R
AU - Ardito, A
AU - Al Ghuzlan, Abir
AU - Quinkler, M
AU - Oßwald, A
AU - Ronchi, CL
AU - de Krijger, Ronald
AU - Feelders, RA
AU - Waldmann, J
AU - Willenberg, HS
AU - Deutschbein, T
AU - Stell, A
AU - Reincke, M
AU - Papotti, M
AU - Baudin, Eric
AU - Tissier, Frédérique
AU - Haak, H
AU - Loli, Paola
AU - Terzolo, Massimo
AU - Allolio, Bruno
AU - Müller, Hans-Helge
AU - Fassnacht, Martin
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background:
Recurrence of adrenocortical carcinoma (ACC) even after complete (R0) resection occurs frequently.
Objective:
The aim of this study was to identify markers with prognostic value for patients in this clinical setting.
Design, Setting, and Participants:
From the German ACC registry, 319 patients with the European Network for the Study of Adrenal Tumors stage I–III were identified. As an independent validation cohort, 250 patients from three European countries were included.
Outcome Measurements and Statistical Analysis:
Clinical, histological, and immunohistochemical markers were correlated with recurrence-free (RFS) and overall survival (OS).
Results:
Although univariable analysis within the German cohort suggested several factors with potential prognostic power, upon multivariable adjustment only a few including age, tumor size, venous tumor thrombus (VTT), and the proliferation marker Ki67 retained significance. Among these, Ki67 provided the single best prognostic value for RFS (hazard ratio [HR] for recurrence, 1.042 per 1% increase; P < .0001) and OS (HR for death, 1.051; P < .0001) which was confirmed in the validation cohort. Accordingly, clinical outcome differed significantly between patients with Ki67 <10%, 10–19%, and ≥20% (for the German cohort: median RFS, 53.2 vs 31.6 vs 9.4 mo; median OS, 180.5 vs 113.5 vs 42.0 mo). Using the combined cohort prognostic scores including tumor size, VTT, and Ki67 were established. Although these scores discriminated slightly better between subgroups, there was no clinically meaningful advantage in comparison with Ki67 alone.
Conclusion:
This largest study on prognostic markers in localized ACC identified Ki67 as the single most important factor predicting recurrence in patients following R0 resection. Thus, evaluation of Ki67 indices should be introduced as standard grading in all pathology reports of patients with ACC.
AB - Background:
Recurrence of adrenocortical carcinoma (ACC) even after complete (R0) resection occurs frequently.
Objective:
The aim of this study was to identify markers with prognostic value for patients in this clinical setting.
Design, Setting, and Participants:
From the German ACC registry, 319 patients with the European Network for the Study of Adrenal Tumors stage I–III were identified. As an independent validation cohort, 250 patients from three European countries were included.
Outcome Measurements and Statistical Analysis:
Clinical, histological, and immunohistochemical markers were correlated with recurrence-free (RFS) and overall survival (OS).
Results:
Although univariable analysis within the German cohort suggested several factors with potential prognostic power, upon multivariable adjustment only a few including age, tumor size, venous tumor thrombus (VTT), and the proliferation marker Ki67 retained significance. Among these, Ki67 provided the single best prognostic value for RFS (hazard ratio [HR] for recurrence, 1.042 per 1% increase; P < .0001) and OS (HR for death, 1.051; P < .0001) which was confirmed in the validation cohort. Accordingly, clinical outcome differed significantly between patients with Ki67 <10%, 10–19%, and ≥20% (for the German cohort: median RFS, 53.2 vs 31.6 vs 9.4 mo; median OS, 180.5 vs 113.5 vs 42.0 mo). Using the combined cohort prognostic scores including tumor size, VTT, and Ki67 were established. Although these scores discriminated slightly better between subgroups, there was no clinically meaningful advantage in comparison with Ki67 alone.
Conclusion:
This largest study on prognostic markers in localized ACC identified Ki67 as the single most important factor predicting recurrence in patients following R0 resection. Thus, evaluation of Ki67 indices should be introduced as standard grading in all pathology reports of patients with ACC.
UR - http://europepmc.org/abstract/med/25559399
U2 - 10.1210/jc.2014-3182
DO - 10.1210/jc.2014-3182
M3 - Article
C2 - 25559399
SN - 0021-972X
VL - 100
SP - 841
EP - 849
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 3
ER -