Faculty Collaboration Database

A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease. Surgery 2014 Dec;156(6):1378-85; discussion 1385-6

Date

12/03/2014

Pubmed ID

25456914

DOI

10.1016/j.surg.2014.08.018

Scopus ID

2-s2.0-84922439155 (requires institutional sign-in at Scopus site)   38 Citations

Abstract

BACKGROUND: Current American Joint Committee on Cancer/International Union against Cancer (AJCC/UICC) and European Network for the Study of Adrenal Tumors staging for adrenocortical carcinoma (ACC) have not shown a survival difference between patients with stage I/II disease. This study evaluates current staging systems for survival prediction using a larger cohort and assesses whether incorporating age into ACC staging improves survival predictions.

METHODS: Patients in the National Cancer Data Base (1985-2006) with a diagnosis of ACC were identified and staged using a novel TNM-A staging system: Stage I (T1/T2N0M0, age ≤ 55), stage II (T1/T2N0M0, age >55), stage III (T1/T2N1M0 or T3/T4N0-N1M0, any age), or stage IV (any T any NM1, any age). Differences in overall survival (OS) by stage were compared using a Cox proportional hazards model.

RESULTS: Staging was derived for 1,579 of 3,262 patients. Median age was 54 years; mean tumor size was 11.6 cm. Using current staging, differences in 5-year OS was observed only between patients with stages II/III and III/IV ACC. With TNM-A staging, differences in 5-year OS between all stages was significant (I/II [P < .003], II/III [P < .0001], III/IV [P < .0001]).

CONCLUSION: A staging system that incorporates patient age better predicts 5-year OS among patients with stages I/II ACC. Consideration should be given to including age in staging for ACC, because it may better inform providers about treatment and prognosis.

Author List

Asare EA, Wang TS, Winchester DP, Mallin K, Kebebew E, Sturgeon C

Author

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Cortex Neoplasms
Adrenocortical Carcinoma
Adult
Aged
Analysis of Variance
Biopsy, Needle
Cohort Studies
Databases, Factual
Disease-Free Survival
Female
Humans
Immunohistochemistry
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Neoplasm Staging
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Young Adult