Validation of the prognostic role of the “Helsinki Score” in 225 cases of adrenocortical carcinoma
Open accessAbstract
Adrenocortical carcinoma patient prognosis is extremely variable and poorly predictable. The newly introduced Helsinki Score is the first so far proposed diagnostic and prognostic system based on the combined evaluation of morphological (mitoses and necrosis) and immunohistochemical (Ki-67) parameters. The aim of the study was to validate the prognostic role of the Helsinki Score for adrenocortical carcinoma characterization. Thus, 225 adrenocortical carcinomas were reclassified using the Weiss Score and the Helsinki Score (3× mitotic count + 5 × necrosis + Ki-67 index). At univariate analysis, statistically significant prognostic values were observed at the log-rank test for mitotic count (cutoff values: <6 and ≥55; P<.0001), Ki-67 (cutoff values: <20 and ≥50; P<.0001), Weiss Score (cutoff values: <5 and ≥8; P<.0001), Helsinki Score (cutoff values: <13 and ≥19; P<.0001), histological variant (conventional versus oncocytic; P=.009), necrosis (P=.001), and stage (P=.005). Cox multivariate analysis using a backward stepwise selection method retained only Helsinki Score and Weiss Score as predictors of poor prognosis (P<.0001 and P=.0005, respectively). Helsinki Score (with a threshold of 28.5 points; area under the curve [AUC]=0.729, 95% confidence interval=0.66-0.79) and Ki-67 (with a threshold of 20.5%; AUC=0.727, 95% confidence interval=0.66-0.79) showed the best and equivalent AUCs predicting disease-related deaths determined using receiver operating characteristic statistics. In conclusion, the Helsinki Score is a valuable system to predict prognosis in adrenocortical carcinoma, outperforming the currently established prognostic parameters.
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The Helsinki score incorporates the Ki67 labeling index and has been proposed to be a better predictor of outcome.
“The Helsinki score used in some centers incorporates the Ki67 labeling index and has been proposed to be a better predictor of outcome (118).”
From Adrenal incidentaloma (2020) · cites this paper as [118]
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References 21 · Cited by 98
- Authors
- Duregon, E., Cappellesso, R., Maffeis, V., Zaggia, B., Ventura, L., Berruti, A., Terzolo, M., Fassina, A., Volante, M., & Papotti, M.
- Affiliations
- University of Turin (IT)
- University of Padua (IT)
- University of Brescia (IT)
- Corresponding author
- Duregon, Eleonora
- ORCID
- Venue
- Human Pathology
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 62
- Pages
- 1-7
- ISSN
- 0046-8177 (ISSN-L)
- OpenAlex
- W2558363806
- Cited by
- 98
- References
- 21
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 6 · 2023: 9 · 2022: 12 · 2021: 17 · 2020: 14 · 2019: 11 · 2018: 9 · 2017: 5
- FWCI
- 9.22
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Human Pathology (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion, cc-by-nc-nd)
- Funders
- Associazione Italiana per la Ricerca sul Cancro
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Sarcoma Diagnosis and Treatment
- Keywords
- adrenocortical carcinoma, Weiss score, Ki-67, mitotic count, tumor necrosis, prognostic scoring, oncocytic variant, disease-related death, prognostic validation
- MeSH terms
- Adolescent, Adrenal Cortex Neoplasms, Adult, Aged, Child, Child, Preschool, Decision Support Techniques, Female, Humans, Immunohistochemistry, Infant, Italy, Male, Middle Aged, Mitosis, Necrosis, Predictive Value of Tests, Prognosis, ROC Curve, Reproducibility of Results, Proportional Hazards Models, Adrenocortical Carcinoma, Ki-67 Antigen, Area Under Curve, Kaplan-Meier Estimate, Young Adult
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