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Cited by 695Adrenal and Paraganglionic TumorsRenal cell carcinoma treatmentAdrenal Hormones and Disorders

Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma: Proposal for a Revised TNM Classification

Fassnacht, Martin, Johanssen, Sarah, Quinkler, Marcus, Bucsky, Peter, Willenberg, Holger S., Beuschlein, Felix, Terzolo, Massimo, Mueller, Hans‐Helge +3 more·2009·Cancer
DOI 10.1002/cncr.24030
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Abstract

BACKGROUND: Adrenocortical carcinoma (ACC) is a rare malignancy, and it was only in 2004 that the International Union Against Cancer (UICC) defined TNM criteria and published the first staging classification. However, to date, the prognostic value of the proposed classification has not been evaluated. METHODS: The German ACC Registry comprising 492 patients was searched for patients who were diagnosed between 1986 and 2007 with detailed information on primary diagnosis and a minimum follow-up of 6 months. Patients were assigned to UICC tumor stage, and disease-specific survival (DSS) was assessed. In addition, the contribution of potential risk factors for DSS was evaluated. RESULTS: In total, 416 patients with a mean follow-up of 36 months met the inclusion criteria (stage I, n=23 patients; stage II, n=176 patients; stage III, n=67 patients; stage IV, n=150 patients). Kaplan-Meier analysis revealed a stage-dependent DSS. However, DSS in patients with stage II ACC did not differ significantly from DSS in patients with stage III ACC (hazard ratio, 1.38; 95% confidence interval, 0.89-2.16). Furthermore, patients who had stage IV ACC without distant metastases had an improved DSS compared with patients who had metastatic disease (P=.004). An analysis of different potential risk factors for defining stage III ACC revealed important roles in DSS for tumor infiltration in surrounding tissue, venous tumor thrombus (VTT), and positive lymph nodes; whereas tumor invasion in adjacent organs carried a prognosis similar to that of infiltration in surrounding tissue only. CONCLUSIONS: The 2004 UICC staging classification for ACC has significant limitations. On the basis of the current analysis, a revised classification with superior prognostic accuracy is proposed (the European Network for the Study of Adrenal Tumors classification). In this system, stage III ACC is defined by the presence of positive lymph nodes, infiltration of surrounding tissue, or VTT; and stage IV ACC is restricted to patients with distant metastasis.

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Crossref · 10.1002/cncr.24030

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  • The ENSAT staging system became widely adopted by the ACC community due to better reflection of stage to patient outcome.

    “This classification system has been recently challenged due to several shortcomings and the newly introduced European Network for the Study of Adrenal Tumors (ENSAT) system became widely adopted by the ACC community due to the better reflection of ENSAT stage to patient outcome (91).”

    From Adrenocortical carcinoma (2014) · cites this paper as [91]

  • These results closely correspond with surgical outcomes from other solid malignancies, in which a survival benefit is often seen after complete resection with negative margins but not in those with positive margins.

    “These results closely correspond with the surgical outcomes from a variety of other solid malignancies, in which a survival benefit is often seen in patients after a complete resection with negative margins but not in those with positive margins (19, 91, 244, 267, 273–275).”

    From Adrenocortical carcinoma (2014) · cites this paper as [91]

  • ACC has a well-documented propensity for lymphatic dissemination, with involved nodal disease in approximately 15% to 27% of patients at the time of surgery.

    “ACC has a well-documented propensity for lymphatic dissemination (11, 91, 351), with involved nodal disease in approximately 15% to 27% of patients at the time of surgery (11, 91).”

    From Adrenocortical carcinoma (2014) · cites this paper as [91]

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Authors
Fassnacht, M., Johanssen, S., Quinkler, M., Bucsky, P., Willenberg, H. S., Beuschlein, F., Terzolo, M., Mueller, H., Hahner, S., Allolio, B., & for the German Adrenocortical Carcinoma Registry Group and the European Network for the Study of Adrenal Tumors
Affiliations
  • University of Würzburg (DE)
  • Charité – Universitätsmedizin Berlin (DE)
  • University of Lübeck (DE)
  • Düsseldorf University Hospital (DE)
  • Ludwig-Maximilians-Universität München (DE)
  • University of Turin (IT)
  • Philipps University of Marburg (DE)
  • Universität Hamburg (DE)
Corresponding author
Fassnacht, Martin
ORCID
Venue
Cancer
Publisher
Wiley
Published
2009-01-07
Volume
115
Issue
2
Pages
243-250
ISSN
  • 0008-543X (ISSN-L)
  • 1097-0142
DOI
10.1002/cncr.24030
OpenAlex
W2102885350
Cited by
695
References
24
Citations by year
2026: 21 · 2025: 25 · 2024: 40 · 2023: 46 · 2022: 49 · 2021: 56 · 2020: 55 · 2019: 38 · 2018: 53 · 2017: 39 · 2016: 41 · 2015: 52 · 2014: 45 · 2013: 31 · 2012: 27
FWCI
26.69
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Cancer (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
adrenocortical carcinoma, prognostic value, disease-specific survival, venous tumor thrombus, lymph node metastasis, tumor infiltration, distant metastasis
MeSH terms
Humans, Lymphatic Metastasis, Neoplasm Invasiveness, Neoplasm Metastasis, Neoplasm Staging, Prognosis, Risk Factors, Adrenocortical Carcinoma

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