1
|
Yasar HA, Aktas BY, Ucar G, Goksu SS, Bilgetekin I, Cakar B, Sakin A, Ates O, Basoglu T, Arslan C, Demiray AG, Paydas S, Cicin I, Sendur MAN, Karadurmus N, Kosku H, Uner A, Yumuk PF, Utkan G, Kefeli U, Tanriverdi O, Cinkir H, Gumusay O, Turhal NS, Menekse S, Kut E, Beypinar I, Sakalar T, Demir H, Yekeduz E, Kilickap S, Erman M, Urun Y. Adrenocortical Cancer in the Real World: A Comprehensive Analysis of Clinical Features and Management from the Turkish Oncology Group (TOG). Clin Genitourin Cancer 2024; 22:102077. [PMID: 38626660 DOI: 10.1016/j.clgc.2024.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare yet highly malignant tumor associated with significant morbidity and mortality. This study aims to delineate the clinical features, survival patterns, and treatment modalities of ACC, providing insights into the disease's prognosis. MATERIALS AND METHODS A retrospective analysis of 157 ACC patients was performed to assess treatment methodologies, demographic patterns, pathological and clinical attributes, and laboratory results. The data were extracted from the hospital's database. Survival analyses were conducted using the Kaplan-Meier method, with univariate and multivariate analyses being performed through the log-rank test and Cox regression analyses. RESULTS The median age was 45, and 89.4% had symptoms at the time of diagnosis. The median tumor size was 12 cm. A total of 117 (79.6%) patients underwent surgery. A positive surgical border was detected in 26 (24.1%) patients. Adjuvant therapy was administered to 44.4% of patients. The median overall survival for the entire cohort was 44.3 months. Median OS was found to be 87.3 months (95% confidence interval [CI] 74.4-100.2) in stage 2, 25.8 (95% CI 6.5-45.1) months in stage 3, and 13.3 (95% CI 7.0-19.6) months in stage 4 disease. Cox regression analysis identified age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as significant factors associated with survival in patients with nonmetastatic disease. In metastatic disease, only patients who underwent surgery exhibited significantly improved overall survival in univariate analyses. CONCLUSION ACC is an uncommon tumor with a generally poor prognosis. Understanding the defining prognostic factors in both localized and metastatic diseases is vital. This study underscores age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as key prognostic determinants for localized disease, offering critical insights into the complexities of ACC management and potential avenues for targeted therapeutic interventions.
Collapse
Affiliation(s)
| | | | - Gokhan Ucar
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | - Irem Bilgetekin
- Medical Oncology Department, Gazi University, Ankara, Turkey
| | - Burcu Cakar
- Medical Oncology Department, Ege University, Izmir, Turkey
| | - Abdullah Sakin
- Medical Oncology Department, Van Yuzuncu Yıl University, Van, Turkey
| | - Ozturk Ates
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Tugba Basoglu
- Medical Oncology Department, Marmara University, Istanbul, Turkey
| | - Cagatay Arslan
- Medical Oncology Department, Bahcesehir University, MedicalPark Hospital, Izmir, Turkey
| | | | - Semra Paydas
- Medical Oncology Department, Adana Cukurova University, Adana, Turkey
| | - Irfan Cicin
- Medical Oncology Department, Trakya University, Edirne, Turkey
| | | | - Nuri Karadurmus
- Medical Oncology Department, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Hakan Kosku
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | - Aytuğ Uner
- Medical Oncology Department, Gazi University, Ankara, Turkey
| | - Perran Fulden Yumuk
- Medical Oncology Department, Marmara University, Istanbul, Turkey; Medical Oncology Department, Koç University, Istanbul; Turkey
| | - Gungor Utkan
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | - Umut Kefeli
- Medical Oncology Department, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Tanriverdi
- Medical Oncology Department, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Havva Cinkir
- Medical Oncology Department, Gaziantep University, Gaziantep, Turkey
| | - Ozge Gumusay
- Medical Oncology Department, Gaziosmanpasa University, Tokat, Turkey
| | | | - Serkan Menekse
- Medical Oncology Department, Manisa City Hospital, Manisa, Turkey
| | - Engin Kut
- Medical Oncology Department, Manisa City Hospital, Manisa, Turkey
| | - Ismail Beypinar
- Medical Oncology Department, Afyon Health Sciences University, Afyon, Turkey
| | - Teoman Sakalar
- Medical Oncology Department, Aksaray University, Aksaray, Turkey
| | - Hacer Demir
- Medical Oncology Department, Afyon Health Sciences University, Afyon, Turkey
| | - Emre Yekeduz
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | | | - Mustafa Erman
- Medical Oncology Department, Hacettepe University, Ankara, Turkey
| | - Yuksel Urun
- Medical Oncology Department, Ankara University, Ankara, Turkey.
| |
Collapse
|
2
|
Zuber SM, Kuchta K, Holoubek SA, Khokar A, Moo-Young T, Prinz RA, Winchester DJ. Validated predictive model for treatment and prognosis of adrenocortical carcinoma. Surgery 2024; 175:743-751. [PMID: 37953139 DOI: 10.1016/j.surg.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Adrenocortical carcinoma has a poor prognosis and multiple clinical, pathological, and treatment variables. Currently, we lack a prognostic and treatment calculator to determine the survival and efficacy of adjuvant chemoradiation. We aimed to validate a calculator to assess prognosis and treatment. METHODS We searched the National Cancer Database to identify patients with adrenocortical carcinoma surgically treated from 2004 to 2020 and randomly allocated them into a training (80%) or validation set (20%). We analyzed the variables of age; sex; Charlson Comorbidity Index; insurance status; tumor size; pathologic tumor, node, and metastasis categories; surgical margins; and use of chemotherapy and radiation therapy. We used Cox regression prediction models and bootstrap coefficients to generate a mathematical model to predict 5- and 10-year overall survival. After using the area under the curve analysis to assess the model's performance, we compared overall survival in the training and validation sets. RESULTS Multivariable analysis of the 3,480 patients included in the study revealed that all variables were significant except sex (P < .05) and incorporated into a mathematical model. The area under the curve for 5- and 10-year overall survival was 0.68 and 0.70, respectively, for the training set and 0.70 and 0.72, respectively, for the validation set. For the bootstrap coefficients, the 5- and 10-year overall survival was 6.4% and 4.1%, respectively, above the observed mean. CONCLUSION Our model predicts the overall survival of patients with adrenocortical carcinoma based on clinical, pathologic, and treatment variables and can assist in individualizing treatment.
Collapse
Affiliation(s)
- Samuel M Zuber
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, University of Chicago Medicine, Chicago, IL.
| | - Kristine Kuchta
- Bioinformatics and Research Core, NorthShore University Health Evanston, IL
| | - Simon A Holoubek
- Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Amna Khokar
- Department of Surgery, John H. Stroger Jr. Cook County Hospital, Chicago, IL
| | - Tricia Moo-Young
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Richard A Prinz
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | |
Collapse
|
3
|
Elhassan YS, Altieri B, Berhane S, Cosentini D, Calabrese A, Haissaguerre M, Kastelan D, Fragoso MCBV, Bertherat J, Al Ghuzlan A, Haak H, Boudina M, Canu L, Loli P, Sherlock M, Kimpel O, Laganà M, Sitch AJ, Kroiss M, Arlt W, Terzolo M, Berruti A, Deeks JJ, Libé R, Fassnacht M, Ronchi CL. S-GRAS score for prognostic classification of adrenocortical carcinoma: an international, multicenter ENSAT study. Eur J Endocrinol 2021; 186:25-36. [PMID: 34709200 PMCID: PMC8679848 DOI: 10.1530/eje-21-0510] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/27/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adrenocortical carcinoma (ACC) has an aggressive but variable clinical course. Prognostic stratification based on the European Network for the Study of Adrenal Tumours stage and Ki67 index is limited. We aimed to demonstrate the prognostic role of a points-based score (S-GRAS) in a large cohort of patients with ACC. DESIGN This is a multicentre, retrospective study on ACC patients who underwent adrenalectomy. METHODS The S-GRAS score was calculated as a sum of the following points: tumour stage (1-2 = 0; 3 = 1; 4 = 2), grade (Ki67 index 0-9% = 0; 10-19% = 1; ≥20% = 2 points), resection status (R0 = 0; RX = 1; R1 = 2; R2 = 3), age (<50 years = 0; ≥50 years = 1), symptoms (no = 0; yes = 1), and categorised, generating four groups (0-1, 2-3, 4-5, and 6-9). Endpoints were progression-free survival (PFS) and disease-specific survival (DSS). The discriminative performance of S-GRAS and its components was tested by Harrell's Concordance index (C-index) and Royston-Sauerbrei's R2D statistic. RESULTS We included 942 ACC patients. The S-GRAS score showed superior prognostic performance for both PFS and DSS, with best discrimination obtained using the individual scores (0-9) (C-index = 0.73, R2D = 0.30, and C-index = 0.79, R2D = 0.45, respectively, all P < 0.01vs each component). The superiority of S-GRAS score remained when comparing patients treated or not with adjuvant mitotane (n = 481 vs 314). In particular, the risk of recurrence was significantly reduced as a result of adjuvant mitotane only in patients with S-GRAS 4-5. CONCLUSION The prognostic performance of S-GRAS is superior to tumour stage and Ki67 in operated ACC patients, independently from adjuvant mitotane. S-GRAS score provides a new important guide for personalised management of ACC (i.e. radiological surveillance and adjuvant treatment).
Collapse
Affiliation(s)
- Y S Elhassan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - B Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - S Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D Cosentini
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - A Calabrese
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - M Haissaguerre
- Service d’Endocrinologie – Diabète et Nutrition CHU de Bordeaux, Bordeaux, France
| | - D Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - M C B V Fragoso
- Unidade de Suprarrenal da Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina do Hospital das Clinicas da Universidade de São Paulo (HCFMUSP), and Instituto do Cancer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - J Bertherat
- Reference Center for Rare Adrenal Cancer (COMETE), Cochin Hospital, Paris, France
| | - A Al Ghuzlan
- Department of Pathology, Gustave Roussy Cancer Center, Paris, France
| | - H Haak
- Department of Internal Medicine, Máxima MC, Eindhoven, Netherlands
| | - M Boudina
- Department of Endocrinology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - L Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - P Loli
- Clinica Polispecialistica San Carlo, Paderno Dugnano, Milano, Italy
| | - M Sherlock
- Department of Endocrinology, Beaumont Hospital, and the Royal College of Surgeons, Dublin, Republic of Ireland
| | - O Kimpel
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - M Laganà
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - A J Sitch
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M Kroiss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
| | - W Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - M Terzolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - A Berruti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - J J Deeks
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Libé
- Department of Endocrinology and Metabolic Diseases, Hôpital Cochin, Paris, France
| | - M Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - C L Ronchi
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Correspondence should be addressed to C L Ronchi;
| | | |
Collapse
|
4
|
Abstract
Adrenocortical carcinoma (ACC) is an extremely rare disease, the incidence of which is 0 [...].
Collapse
|
5
|
Lam AKY. Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging. Biomedicines 2021; 9:biomedicines9020175. [PMID: 33578929 PMCID: PMC7916702 DOI: 10.3390/biomedicines9020175] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a heterogenous group of diseases with different clinical behaviour between adult and paediatric patients. In addition, three histological variants, oncocytic, myxoid and sarcomatoid are noted on the recent World Health Organisation (WHO) classification of ACC. A review of recent literature showed that the different types of ACC have distinctive demographic data, clinical presentation, pathology, biological behaviour, genomic and patients' prognosis. In addition, recent updates of pathology staging for ACC allow refinement of prognostic grouping for planning treatment of the patients with ACC. These advances in genomic, pathology and staging have driven the development of standardisation of pathology reporting. International standardisation of pathological reporting of adrenocortical carcinoma and adaption to local pathology communities provide universal platforms for clinicians and researchers involved in the management of patients with ACC. To conclude, all these advances in the field of pathology will improve development of management strategies including improvement of clinical care, development of prognostic markers and testing of novel therapeutic approaches for patients with adrenocortical carcinoma.
Collapse
Affiliation(s)
- Alfred King-yin Lam
- School of Medicine, Griffith University, Gold Coast, QLD 4222, Australia;
- Pathology Queensland, Gold Coast University Hospital, Southport, Gold Coast, QLD 4215, Australia
- Faculty of Medicine, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
| |
Collapse
|