A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the US Adrenocortical Carcinoma Study Group - PubMed (original) (raw)
. 2018 Feb;25(2):520-527.
doi: 10.1245/s10434-017-6236-1. Epub 2017 Nov 21.
Cecilia G Ethun 1, Lauren M Postlewait 1, Thuy B Tran 2, Jason D Prescott 3, Timothy M Pawlik 3, Tracy S Wang 4, Jason Glenn 4, Ioannis Hatzaras 5, Rivfka Shenoy 5, John E Phay 6, Kara Keplinger 6, Ryan C Fields 7, Linda X Jin 7, Sharon M Weber 8, Ahmed Salem 8, Jason K Sicklick 9, Shady Gad 9, Adam C Yopp 10, John C Mansour 10, Quan-Yang Duh 11, Natalie Seiser 11, Carmen C Solórzano 12, Colleen M Kiernan 12, Konstantinos I Votanopoulos 13, Edward A Levine 13, Charles A Staley 1, George A Poultsides 2, Shishir K Maithel 14 15
Affiliations
- PMID: 29164414
- PMCID: PMC6087546
- DOI: 10.1245/s10434-017-6236-1
A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the US Adrenocortical Carcinoma Study Group
Caroline E Poorman et al. Ann Surg Oncol. 2018 Feb.
Abstract
Background: The 7th AJCC T-stage system for adrenocortical carcinoma (ACC), based on size and extra-adrenal invasion, does not adequately stratify patients by survival. Lymphovascular invasion (LVI) is a known poor prognostic factor. We propose a novel T-stage system that incorporates LVI to better risk-stratify patients undergoing resection for ACC.
Method: Patients undergoing curative-intent resections for ACC from 1993 to 2014 at 13 institutions comprising the US ACC Group were included. Primary outcome was disease-specific survival (DSS).
Results: Of the 265 patients with ACC, 149 were included for analysis. The current T-stage system failed to differentiate patients with T2 versus T3 disease (p = 0.10). Presence of LVI was associated with worse DSS versus no LVI (36 mo vs. 168 mo; p = 0.001). After accounting for the individual components of the current T-stage system (size, extra-adrenal invasion), LVI remained a poor prognostic factor on multivariable analysis (hazard ratio 2.14, 95% confidence interval 1.05-4.38, p = 0.04). LVI positivity further stratified patients with T2 and T3 disease (T2: 37 mo vs. median not reached; T3: 36 mo vs. 96 mo; p = 0.03) but did not influence survival in patients with T1 or T4 disease. By incorporating LVI, a new T-stage classification system was created: [T1: ≤ 5 cm, (-)local invasion, (+/-)LVI; T2: > 5 cm, (-)local invasion, (-)LVI OR any size, (+)local invasion, (-)LVI; T3: > 5 cm, (-)local invasion, (+)LVI OR any size, (+)local invasion, (+)LVI; T4: any size, (+)adjacent organ invasion, (+/-)LVI]. Each progressive new T-stage group was associated with worse median DSS (T1: 167 mo; T2: 96 mo; T3: 37 mo; T4: 15 mo; p < 0.001).
Conclusions: Compared with the current T-stage system, the proposed T-stage system, which incorporates LVI, better differentiates T2 and T3 disease and accurately stratifies patients by disease-specific survival. If externally validated, this T-stage classification should be considered for future AJCC staging systems.
Figures
FIG. 1
AJCC 7th/8th edition and proposed T-stage classification systems
FIG. 2
AJCC 7th/8th T-stage system, LVI stratification of 7th/8th AJCC T-stage, and proposed T-stage system
FIG. 3
Lymphovascular invasion
Comment in
- ASO Author Reflections: Incorporating Lymphovascular Invasion to Improve the Prognostic Reliability of the T-Staging System for Adrenocortical Carcinoma-A Multicenter Study.
Poorman CE, Ethun CG, Maithel SK. Poorman CE, et al. Ann Surg Oncol. 2018 Dec;25(Suppl 3):862-863. doi: 10.1245/s10434-018-6876-9. Epub 2018 Oct 8. Ann Surg Oncol. 2018. PMID: 30298330 No abstract available.
References
- Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol. 1999;6:719–26. -PubMed
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