Prognostic parameters of metastatic adrenocortical carcinoma
Abstract
CONTEXT: Prognostic parameters of metastatic adrenocortical carcinoma (ACC) are poorly characterized. OBJECTIVE: The objective of the study was to describe the clinical presentation of metastatic ACC and determine prognostic factors for survival. DESIGN: This was a retrospective cohort study (1988-2004). SETTING: The study was conducted in an institutional practice. PATIENTS: Participants included 124 consecutive patients with metastatic ACC, 70 from Gustave-Roussy Institute (main cohort) and 54 patients from the Cochin Hospital (validation cohort). Clinical data concerning all patients, histopathologic slides of primary tumors (44 in the main cohort and 40 in the validation cohort), and molecular biology data on 15 primary tumors (main cohort) were analyzed. INTERVENTION: There was no intervention. MAIN OUTCOME: The main outcome was the specific survival after discovery of the first metastasis (Kaplan-Meier method). This included univariate analysis on the main cohort, confirmed on the validation cohort and then analyzed in a multivariate analysis. RESULTS: In the main cohort, overall median survival was 20 months. In univariate analysis, the presence of hepatic and bone metastases, the number of metastatic lesions and the number of tumoral organs at the time of the first metastasis, a high mitotic rate (>20 per 50 high-power field), and atypical mitoses in the primary tumor predicted survival (P = 0.05, 0.003, 0.046, 0.001, 0.01, and < 0.001, respectively). The number of tumoral organs and a high mitotic rate were confirmed on the validation cohort (P = 0.009 and 0.03, respectively). These two parameters were confirmed in multivariate analysis (P = 0.0058 and 0.049). CONCLUSION: Metastatic ACC is a heterogeneous disease with poor outcome. The combination of the number of tumoral organs at the time of the first metastasis and the mitotic rate can predict different outcomes.
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Tumor extent (stage), specifically presence of distant metastasis and number of organs involved, confers a worse prognosis.
“Tumor extent (eg, stage), specifically the presence of distant metastasis and number of organs involved in metastatic disease, confers a worse prognosis (243, 244).”
From Adrenocortical carcinoma (2014) · cites this paper as [243]
Age at diagnosis is correlated with decreased overall survival.
“Naturally, age at diagnosis is correlated with decreased overall survival (243).”
From Adrenocortical carcinoma (2014) · cites this paper as [243]
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 [243]
The number of organs involved by tumor at the time of the first metastasis is a predictor of survival.
“The number of organs involved by tumor at the time of the first metastasis is a predictor of survival (243, 265).”
From Adrenocortical carcinoma (2014) · cites this paper as [243]
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- Authors
- Assié, G., Antoni, G., Tissier, F., Caillou, B., Abiven, G., Gicquel, C., Leboulleux, S., Travagli, J.-P., Dromain, C., Bertagna, X., Bertherat, J., Schlumberger, M., & Baudin, E.
- Affiliations
- Service de Médecine Nucléaire et de Cancérologie Endocrinienne (G.As., S.L., J.-P.T., C.D., M.S., E.B.), Institut Gustave-Roussy, Université Paris XI, 94800 Villejuif, France
- Institut Gustave Roussy (FR)
- Département d’Anatomo-Pathologie (F.T.), Hôpital Cochin, Université Paris V René Descartes, Faculté de Médécine, Site Cochin-Port-Royal, 75014 Paris, France
- Hôpital Cochin (FR)
- Inserm (FR)
- Centre National de la Recherche Scientifique (FR)
- Service d’Endocrinologie (G.Ab., X.B., J.B.), Hôpital Cochin, Université Paris V René Descartes, Faculté de Médécine, Site Cochin-Port-Royal, 75014 Paris, France
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2007-01-01
- Volume
- 92
- Issue
- 1
- Pages
- 148-154
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2114699004
- Cited by
- 236
- References
- 54
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 13 · 2023: 14 · 2022: 10 · 2021: 18 · 2020: 10 · 2019: 16 · 2018: 13 · 2017: 8 · 2016: 7 · 2015: 14 · 2014: 18 · 2013: 11 · 2012: 11
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (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
- metastatic adrenocortical carcinoma, prognostic factors, survival, mitotic activity, atypical mitoses, liver metastasis, bone metastasis, number of metastatic lesions, clinical features
- MeSH terms
- Adolescent, Adrenal Cortex Neoplasms, Adult, Aged, Bone Neoplasms, Female, Humans, Liver Neoplasms, Male, Middle Aged, Prognosis, Retrospective Studies, Cohort Studies, Survival Rate, Multivariate Analysis, Loss of Heterozygosity
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