TY - JOUR
T1 - A Novel T-Stage Classification System for Adrenocortical Carcinoma
T2 - Proposal from the US Adrenocortical Carcinoma Study Group
AU - Poorman, Caroline E.
AU - Ethun, Cecilia G.
AU - Postlewait, Lauren M.
AU - Tran, Thuy B.
AU - Prescott, Jason D.
AU - Pawlik, Timothy M.
AU - Wang, Tracy S.
AU - Glenn, Jason
AU - Hatzaras, Ioannis
AU - Shenoy, Rivfka
AU - Phay, John E.
AU - Keplinger, Kara
AU - Fields, Ryan C.
AU - Jin, Linda X.
AU - Weber, Sharon M.
AU - Salem, Ahmed
AU - Sicklick, Jason K.
AU - Gad, Shady
AU - Yopp, Adam C.
AU - Mansour, John C.
AU - Duh, Quan Yang
AU - Seiser, Natalie
AU - Solórzano, Carmen C.
AU - Kiernan, Colleen M.
AU - Votanopoulos, Konstantinos I.
AU - Levine, Edward A.
AU - Staley, Charles A.
AU - Poultsides, George A.
AU - Maithel, Shishir K.
N1 - Publisher Copyright:
© 2017, Society of Surgical Oncology.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/85034668895
U2 - 10.1245/s10434-017-6236-1
DO - 10.1245/s10434-017-6236-1
M3 - Article
C2 - 29164414
AN - SCOPUS:85034668895
SN - 1068-9265
VL - 25
SP - 520
EP - 527
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 2
ER -