TY - JOUR
T1 - Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study
AU - Libe', Rossella
AU - Ronchi, Cristina
AU - Borget, I
AU - Zaggia, B
AU - Kroiss, Matthias
AU - Kerkhofs, T
AU - Bertherat, Jerome
AU - Volante, Marco
AU - Quinkler, Markus
AU - Chabre, Olivier
AU - Bala, Margarita
AU - Tabarin, Antoine
AU - Beuschlein, Felix
AU - Vezzosi, D
AU - Deutschbein, Timo
AU - Borson-Chazot, F
AU - Hermsen, I
AU - Stell, A
AU - Fottner, C
AU - Leboulleux, S
AU - Hahner, Stefanie
AU - Mannelli, Massimo
AU - Berruti, Alfredo
AU - Haak, H
AU - Terzolo, Massimo
AU - Fassnacht, Martin
AU - Baudin, Eric
PY - 2015/10
Y1 - 2015/10
N2 - 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.
AB - 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.
KW - Adrenocortical carcinoma
KW - Prognostic factors
KW - ENSAT
KW - GRAS
U2 - 10.1093/annonc/mdv329
DO - 10.1093/annonc/mdv329
M3 - Article
SN - 0923-7534
VL - 26
SP - 2119
EP - 2125
JO - Annals of Oncology
JF - Annals of Oncology
IS - 10
ER -