A Revised Version of the TNM Classification Leads to Optimized Predictive Performance in Patients with Adrenocortical Carcinoma

Abstract

The prognostic stratification of the current AJCC/UICC TNM classification for adrenocortical carcinoma (ACC) has been validated in only a few studies. In this study, it was hypothesized that redefining the T category cut-off would result in a significant improvement in estimated stage-related survival. In 935 patients with ACC from the SEER database, optimal cut-off values based on tumor size were first determined to redefine T1 and T2 categories. Cox proportional hazards regression analysis and receiver operating characteristics (ROC) were then used to determine the prognostic value of the revised version. A new cut-off value of 9.5 cm tumor size was established to differentiate between T1 and T2 tumors, leading to a revised TNM classification. As a result, a more homogeneous distribution of patients with ACC across all stages was observed. Notably, the predictive value of the newly proposed TNM classification in the ROC analysis exceeded that of the 7th and 8th editions of the AJCC/UICC classification system. Finally, the prognostic superiority of the revised TNM classification was confirmed in a multivariate Cox proportional hazards regression model. In conclusion, the present study demonstrates that updating the current staging system with revised T1 and T2 categories significantly improves the prediction of cancer-specific survival (CSS) in patients with ACC.

Surgical management of metastatic adrenocortical carcinoma

“…Patients often present with large, high‐grade tumors and distant metastases at diagnosis. While disease‐specific five‐year survival in early‐stage ACC may be as high as 60%, patients with metastatic disease have exceptionally poor outcomes, with a five‐year survival as low as 10.2% 1–11 . With an estimated annual incidence of two or fewer cases per million, however, ACC remains quite rare 1,2,4–8 …”

“…While disease-specific five-year survival in early-stage ACC may be as high as 60%, patients with metastatic disease have exceptionally poor outcomes, with a fiveyear survival as low as 10.2%. [1][2][3][4][5][6][7][8][9][10][11] With an estimated annual incidence of two or fewer cases per million, however, ACC remains quite rare. 1,2,[4][5][6][7][8] While surgical resection is the mainstay of therapy in nonmetastatic ACC, management of metastatic ACC relies primarily on systemic chemotherapy.…”