Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study

Research output: Contribution to journalArticlepeer-review

Authors

  • Rossella Libe'
  • I Borget
  • B Zaggia
  • Matthias Kroiss
  • T Kerkhofs
  • Jerome Bertherat
  • Marco Volante
  • Markus Quinkler
  • Olivier Chabre
  • Margarita Bala
  • Antoine Tabarin
  • Felix Beuschlein
  • D Vezzosi
  • Timo Deutschbein
  • F Borson-Chazot
  • I Hermsen
  • A Stell
  • C Fottner
  • S Leboulleux
  • Stefanie Hahner
  • Massimo Mannelli
  • Alfredo Berruti
  • H Haak
  • Massimo Terzolo
  • Martin Fassnacht
  • Eric Baudin

Colleges, School and Institutes

Abstract

Background The clinical course of advanced adrenocortical carcinoma (ACC) is heterogeneous. Our study aimed primarily to refine and make headway in the prognostic stratification of advanced ACC. Patients and methods Patients with advanced ENSAT ACC (stage III or stage IV) at diagnosis registered between 2000 and 2009 in the ENSAT database were enrolled. The primary end point was overall survival (OS). Parameters of potential prognostic relevance were selected. Univariate and multivariate analyses were carried out: model 1 ‘before surgery’; model 2 ‘post-surgery’. Results Four hundred and forty-four patients with advanced ENSAT ACC (stage III: 210; stage IV: 234) were analyzed. After a median follow-up of 55.2 months, the median OS was 24 months. A modified ENSAT (mENSAT) classification was validated: stage III (invasion of surrounding tissues/organs or the vena renalis/cava) and stage IVa, IVb, IVc (2, 3 or >3 metastatic organs, including N, respectively). Two- or 5-year OS was 73%, 46%, 26% and 15% or 50%, 15%, 14% and 2% for stages III, IVa, IVb and IVc, respectively. In the multivariate analysis, mENSAT stages (stages IVa, IVb, or IVc, respectively) were significantly correlated with OS (P < 0.0001), as well as additional parameters: age ≥50 years (P < 0.0001), tumor- or hormone-related symptoms (P = 0.01 and 0.03, respectively) in model 1 but also the R status (P = 0.001) and Grade (Weiss >6 and/or Ki67 ≥20%, P = 0.06) in model 2. Conclusion The mENSAT classification and GRAS parameters (Grade, R status, Age and Symptoms) were found to best stratify the prognosis of patients with advanced ACC.

Details

Original languageEnglish
Pages (from-to)2119-2125
Number of pages7
JournalAnnals of Oncology
Volume26
Issue number10
Publication statusPublished - Oct 2015

Keywords

  • Adrenocortical carcinoma, Prognostic factors, ENSAT, GRAS