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Evanoff JD, Patel SG, Hickey KJ, Rensing AJ. Survival characteristics of localized pediatric adrenocortical carcinoma managed with adenectomy: A national cancer center database analysis. J Pediatr Urol 2021; 17:735.e1-735.e6. [PMID: 34210620 DOI: 10.1016/j.jpurol.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pediatric adrenocortical carcinoma (ACC) is a rare malignancy, encompassing less than 0.2% of all childhood malignancies. Due to the scarcity of this diagnosis, it is often managed according to guidelines established for adults, as there is a lack of reliable evidence regarding optimal adjuvant treatment options for pediatric patients. It is our aim to identify recent treatment trends as well as clinical and tumor characteristics and their impact on overall survival. METHODS Using the National Cancer Data Base (NCDB), this study identified 49 patients under 18 years old with localized ACC (M0) undergoing adrenalectomy from 2004 to 2017. Kaplan-Meier analysis was performed to determine overall survival (OS) from patient characteristics and treatments received. Comparison of survival was performed using the log rank test. RESULTS The median age of our cohort was 3 years old with a slight female predominance of 61%. The median tumor size was 9.4 cm, and patients older than 4 years were significantly (p = 0.03) more likely to present with larger tumors (11.33 cm vs 8.76 cm). Adjuvant treatment in the form of systemic therapy was administered in 20 of 49 (41%) patients and radiation therapy in 2 of 49 (4%) patients. Three-year OS for patients 4 years old and younger was 92.6% vs 61.8% for those older than 4 years (p = 0.002). Patients presenting with tumor size ≥9 cm had worse three-year OS compared to those with tumors <9 cm (95.24% vs 67.1% respectively, p = 0.02, Fig. 1). In patients with tumors ≥ 9 cm, younger children age 0-4 years had significantly (p = 0.04) higher OS rates than older children age 5-17 years. CONCLUSIONS ACC is a rare pediatric malignancy with a female predominance. Those older than 4 years and those with presenting tumor size ≥9 cm have decreased overall survival rates after adrenalectomy for localized disease. Additionally, children older than 4 have poorer prognosis, even after controlling for larger tumor size. This is the largest contemporary series of localized pediatric ACC to date. However, multi-institutional prospective cohort or randomized-controlled trials are necessary to better evaluate relevant prognostic factors and the role of adjuvant therapies following adrenalectomy.
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Affiliation(s)
- Jaisa D Evanoff
- College of Medicine, University of Oklahoma, 940 Stanton L Young Blvd #357, Oklahoma City, OK, 73104, USA
| | - Sanjay G Patel
- Department of Urology, University of Oklahoma, 920 Stanton L. Young Blvd, WP 2140, Oklahoma City, OK, 73104, USA
| | - Kyle J Hickey
- College of Medicine, University of Oklahoma, 940 Stanton L Young Blvd #357, Oklahoma City, OK, 73104, USA
| | - Adam J Rensing
- Department of Urology, University of Oklahoma, 920 Stanton L. Young Blvd, WP 2140, Oklahoma City, OK, 73104, USA.
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Marti N, Malikova J, Galván JA, Aebischer M, Janner M, Sumnik Z, Obermannova B, Escher G, Perren A, Flück CE. Androgen production in pediatric adrenocortical tumors may occur via both the classic and/or the alternative backdoor pathway. Mol Cell Endocrinol 2017; 452:64-73. [PMID: 28501574 DOI: 10.1016/j.mce.2017.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/24/2017] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
Children with adrenocortical tumors (ACTs) often present with virilization due to high tumoral androgen production, with dihydrotestosterone (DHT) as most potent androgen. Recent work revealed two pathways for DHT biosynthesis, the classic and the backdoor pathway. Usage of alternate routes for DHT production has been reported in castration-resistant prostate cancer, CAH and PCOS. To assess whether the backdoor pathway may contribute to the virilization of pediatric ACTs, we investigated seven children suffering from androgen producing tumors using steroid profiling and immunohistochemical expression studies. All cases produced large amounts of androgens of the classic and/or backdoor pathway. Variable expression of steroid enzymes was observed in carcinomas and adenomas. We found no discriminative pattern. This suggests that enhanced androgen production in pediatric ACTs is the result of deregulated steroidogenesis through multiple steroid pathways. Thus future treatments of ACTs targeting androgen overproduction should consider these novel steroid production pathways.
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Affiliation(s)
- Nesa Marti
- Pediatric Endocrinology and Diabetology, Department of Pediatrics, Switzerland; Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland; Graduate School Bern, University of Bern, Switzerland
| | - Jana Malikova
- Pediatric Endocrinology and Diabetology, Department of Pediatrics, Switzerland; Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
| | - José A Galván
- Institute of Pathology, University of Bern, Switzerland
| | - Maude Aebischer
- Pediatric Endocrinology and Diabetology, Department of Pediatrics, Switzerland
| | - Marco Janner
- Pediatric Endocrinology and Diabetology, Department of Pediatrics, Switzerland
| | - Zdenek Sumnik
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
| | - Barbora Obermannova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
| | - Genevieve Escher
- Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Nephrology and Hypertension, Bern University Hospital, University of Bern, Switzerland
| | - Aurel Perren
- Institute of Pathology, University of Bern, Switzerland
| | - Christa E Flück
- Pediatric Endocrinology and Diabetology, Department of Pediatrics, Switzerland; Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Ru W, Yang M, Xu S, Li M, Tang D. Management and prognosis of adrenocortical tumors in children: can we find out an appropriate points-scoring system to predict prognosis? Pediatr Surg Int 2017; 33:705-711. [PMID: 28260193 DOI: 10.1007/s00383-017-4073-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND/PURPOSE Adrenocortical tumors (ACTs) are rare in childhood. There are no recognized criteria to exactly distinguish between benign and malignant forms, or predict prognosis. The incidence of tumor varies across geographic regions or ethnicities, as well as malignant proportion. The aim of this study is to examine a single institution's experience with pediatric ACTs and to validate the prognostic value of the biologic/pathologic criteria of Wienecke. METHODS Records of 26 pediatric ACTs between 1994 and 2016 in our center were reviewed retrospectively. The data recorded of each patient included clinical characteristics, treatment, pathologic findings, disease stating, and outcome. Tumors were categorized according to the Wienecke criteria. RESULTS All patients underwent primary surgical excision, including negative margins in 20 cases. Stage distribution at diagnosis was: ST I 12, ST II 8, ST III 5, and ST IV 1. According to Wienecke scoring system, 13 cases were <3 criteria, 6 cases were =3 criteria, and 7 cases were >3 criteria. At median follow-up of 34.5 months, 18 patients survived without evidence of disease and 8 patients had lethal outcome. There was a strong association between high Wienecke score and both high stage and adverse outcome. CONCLUSIONS Wienecke criteria can be an appropriate points-scoring system to predict prognosis for adrenocortical tumors in children. Complete surgical resection with negative margins is optimal for survival.
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Affiliation(s)
- Wei Ru
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Min Yang
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Shan Xu
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China.
| | - Minju Li
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Daxing Tang
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
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Das S, Sengupta M, Islam N, Roy P, Datta C, Mishra PK, Banerjee S, Chaudhuri MK, Chatterjee U. Weineke criteria, Ki-67 index and p53 status to study pediatric adrenocortical tumors: Is there a correlation? J Pediatr Surg 2016; 51:1795-1800. [PMID: 27567308 DOI: 10.1016/j.jpedsurg.2016.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/21/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Adrenocortical tumors (ACTs) are rare in pediatric age group. Pediatric ACTs behave differently from their histologically similar adult counterparts and Weiss criteria often cannot accurately predict their clinical behavior. Wieneke et al. proposed a set of 9 macroscopic and microscopic criteria for diagnosis of malignancy in pediatric ACTs. The aim of the present study was to validate the Wieneke criteria in pediatric ACTs and to correlate Ki-67 labeling index and p53 expression with the Wieneke score. METHODS Our study comprised 17 cases of pediatric ACTs more than 11years, from January 2005 to December 2015. Relevant clinical features were obtained from records. Comprehensive analysis of gross and microscopic features was performed, according to the criteria proposed by Wieneke et al. Each tumor was categorized as benign, intermediate for malignancy or malignant. Ki-67 and p53 immunostaining was done in all cases. The patients were followed-up over a period of 6months to 60months. RESULTS Applying Wieneke criteria, there were 9 benign and 7 malignant cases, and 1 case was assigned as intermediate for malignancy. The most significant markers in favor of malignancy were capsular and venous invasion, followed by the presence of mitotic figures >15/20 HPF. p53 was over-expressed in 86% of the carcinomas. We found a significant correlation between Ki-67 index and Wieneke scoring system. All cases of adenoma achieved complete remission, while 3 patients with carcinoma died. CONCLUSION Our study validates the utility of Wieneke criteria in differentiating adrenocortical carcinomas from adenomas in pediatric age group. Moreover, Ki-67 index and p53 status can be used as supplementary tools in distinguishing adrenocortical carcinomas from adenomas.
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Affiliation(s)
- Soutrik Das
- Department of Pathology, IPGME&R, Kolkata, India.
| | | | | | | | | | | | - Sugato Banerjee
- Department of Pediatric Surgery, Park Clinic, Kolkata, India.
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Dall'Igna P, Virgone C, De Salvo GL, Bertorelle R, Indolfi P, De Paoli A, Buffa P, Conte M, Esposito G, Inserra A, Candiotto C, D'Onofrio V, Boldrini R, Ferrari A, Bisogno G, Alaggio R, Cecchetto G. Adrenocortical tumors in Italian children: analysis of clinical characteristics and P53 status. Data from the national registries. J Pediatr Surg 2014; 49:1367-71. [PMID: 25148739 DOI: 10.1016/j.jpedsurg.2014.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 11/26/2022]
Abstract
AIM Adrenocortical tumors are very rare in children. The distinction between adenoma and carcinoma is complex because of their clinical/histological characteristics. The analysis of the cases registered in two consecutive Italian Studies is described, in order to provide additional insight into their nature and possibly identify benign and malignant lesions. MATERIALS AND METHODS The analysis includes patients registered from?? 1.1982 to 6.2011 into two consecutive Italian protocols. RESULTS Fifty-eight children (age 2-210months) were evaluated. Endocrine manifestations were the most frequent symptoms. Stage distribution at diagnosis was: ST I 35, ST II 17, ST III 1, ST IV 5. Treatment consisted in mitotane for ST II, mitotane+chemotherapy for ST III/IV. Forty-four patients are alive without evidence of disease, 1 is alive with disease, 12 died of disease and 1 because of cardiomyopathy. The Wienecke score system was applied in 24 patients with good significance. A p53 mutation was found in 7 cases, and it was diagnostic for Li-Fraumeni syndrome in 2 benign tumors. CONCLUSIONS The results highlight the importance of a complete excision to obtain the cure of patients. The efficacy of chemotherapy is controversial, however it was able to control the disease in 4 patients in ST II. The value of the Wienecke score system in predicting patients' outcome was confirmed. p53 mutation was more frequent in malignant tumors and represented the sentinel of the Li-Fraumeni syndrome.
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Affiliation(s)
- Patrizia Dall'Igna
- Pediatric Surgery Department, University-Hospital of Padua, Padua, Italy
| | - Calogero Virgone
- Pediatric Surgery Department, University-Hospital of Padua, Padua, Italy.
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Roberta Bertorelle
- Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Paolo Indolfi
- Pediatric Department, Pediatric Oncology Service, Second University of Naples, Naples, Italy
| | - Angela De Paoli
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Piero Buffa
- Pediatric Surgery Department, Istituto Giannina Gaslini, Genova, Italy
| | - Massimo Conte
- Pediatric Oncology Department, Istituto Giannina Gaslini, Genova, Italy
| | - Giovanni Esposito
- Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | | | - Cinzia Candiotto
- Immunologia e Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Vittoria D'Onofrio
- Servizio di Anatomia e Istologia Patologica, Azienda Ospedaliera di Rilievo Nazionale, Santobono Pausillipon, Naples, Italy
| | | | - Andrea Ferrari
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Gianni Bisogno
- Pediatric Oncology Department, University-Hospital of Padua, Padua, Italy
| | - Rita Alaggio
- Pathology Department, University-Hospital of Padua, Padua, Italy
| | - Giovanni Cecchetto
- Pediatric Surgery Department, University-Hospital of Padua, Padua, Italy
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