Proposal for modification of the ENSAT staging system for adrenocortical carcinoma using tumor grade
Abstract
Purpose Various staging systems for adrenocortical carcinoma (ACC) have been proposed. We hypothesized that incorporating tumor grade into the current European Network for the Study of Adrenal Tumors (ENSAT) staging system would improve the ability to more accurately predict time to recurrence and death.Methods A retrospective review of patients included in the University of Michigan ACC database from 2005 to 2009 was done; and stage, tumor grade, time to recurrence, and death were recorded and analyzed using the Cox regression and Kaplan-Meier survival curves.Results Ninety one patients had complete information for inclusion. The median follow-up was 24 months while the median time to recurrence was 4.1 months. There were 28 deaths; overall, tumor grade showed a significant difference in time to tumor recurrence (p = 0.011) and time to death (p = 0.004). Time to death among stage 2 patients separated into those with high- and low-grade tumors reached statistical significance (p = 0.05), and notable but not statistically significant differences were identified in all stages. Based on tumor grade and survival curves, modifications to the current ENSAT staging system were made.Conclusion Tumor grade plays a significant role in the outcome of patients with ACC. High-grade tumors are associated with shorter disease-free intervals and shorter overall survival. The proposed modification of the ENSAT staging system allows for incorporation of tumor grade when predicting overall survival.
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High tumor grade (>20 mitoses per HPF) is an unfavorable prognostic indicator.
“High tumor grade (>20 mitoses per HPF) is also an unfavorable prognostic indicator (245).”
From Adrenocortical carcinoma (2014) · cites this paper as [245]
Tumor grade correlates with survival.
“Tumor grade influences the decision for reoperation because it correlates with survival (243, 245).”
From Adrenocortical carcinoma (2014) · cites this paper as [245]
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LONG-TERM RESULTS OF SURGICAL TREATMENT FOR ADRENOCORTICAL CANCER
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- Authors
- Miller, B. S., Gauger, P. G., Hammer, G. D., Giordano, T. J., & Doherty, G. M.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Miller, Barbra S.
- Venue
- Langenbeck s Archives of Surgery
- Published
- 2010-08-09
- Volume
- 395
- Issue
- 7
- Pages
- 955-961
- ISSN
- 0023-8236 (ISSN-L)
- 1435-2443
- 1435-2451
- OpenAlex
- W2044712887
- Cited by
- 84
- References
- 27
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 7 · 2022: 6 · 2021: 8 · 2020: 8 · 2019: 7 · 2018: 6 · 2017: 1 · 2016: 5 · 2015: 9 · 2014: 10 · 2013: 6 · 2012: 1
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Langenbeck s Archives of Surgery (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, tumor grade, tumor staging, time to recurrence, overall survival, disease-free interval, prognostic factors
- MeSH terms
- Adolescent, Adrenal Cortex Neoplasms, Adrenalectomy, Adult, Aged, Biopsy, Needle, Female, Follow-Up Studies, Forecasting, Humans, Immunohistochemistry, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Retrospective Studies, Sensitivity and Specificity, Time Factors, Cohort Studies, Proportional Hazards Models, Survival Analysis, Treatment Outcome, Adrenocortical Carcinoma, Risk Assessment, Statistics, Nonparametric, Kaplan-Meier Estimate, Young Adult
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