Jordan J Baechle1,2, Paula Marincola Smith1, Carmen C Solórzano1, Thuy B Tran3, Lauren M Postlewait4, Shishir K Maithel4, Jason Prescott5, Timothy Pawlik5, Tracy S Wang6, Jason Glenn6, Ioannis Hatzaras7, Rivfka Shenoy7, John E Phay8, Lawrence A Shirley8, Ryan C Fields9, Linda Jin9, Daniel E Abbott10, Sean Ronnekleiv-Kelly10, Jason K Sicklick11, Adam Yopp12, John Mansour12, Quan-Yang Duh13, Natalie Seiser13, Konstantinos Votanopoulos14, Edward A Levine14, George Poultsides3, Colleen M Kiernan15. 1. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 2. School of Medicine, Meharry Medical College, Nashville, TN, USA. 3. Department of Surgery, Stanford Medical Center, Stanford, CA, USA. 4. Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 5. Department of Surgery, The Johns Hopkins Medical Center, Baltimore, MD, USA. 6. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 7. Department of Surgery, New York University Langone Health, New York, NY, USA. 8. Department of Surgery, The Ohio State University, Columbus, OH, USA. 9. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. 10. Department of General Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA. 11. Department of Surgery, University of California San Diego, San Diego, CA, USA. 12. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 13. Department of Surgery, University of California San Francisco, San Francisco, CA, USA. 14. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. 15. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. colleen.m.kiernan@vumc.org.
Abstract
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare but aggressive malignancy, and many prognostic factors that influence survival remain undefined. Individually, the GRAS (Grade, Resection status, Age, and Symptoms of hormone hypersecretion) parameters have demonstrated their prognostic value in ACC. This study aimed to assess the value of a cumulative GRAS score as a prognostic indicator after ACC resection. METHODS: A retrospective cohort study of adult patients who underwent surgical resection for ACC between 1993 and 2014 was performed using the United States Adrenocortical Carcinoma Group (US-ACCG) database. A sum GRAS score was calculated for each patient by adding one point each when the criteria were met for tumor grade (Weiss criteria ≥ 3 or Ki67 ≥ 20%), resection status (micro- or macroscopically positive margin), age (≥ 50 years), and preoperative symptoms of hormone hypersecretion (present). Overall survival (OS) and disease-free survival (DFS) by cumulative GRAS score were analyzed by the Kaplan-Meier method and log-rank test. RESULTS: Of the 265 patients in the US-ACCG database, 243 (92%) had sufficient data available to calculate a cumulative GRAS score and were included in this analysis. The 265 patients comprised 23 patients (10%) with a GRAS of 0, 52 patients (21%) with a GRAS of 1, 92 patients (38%) with a GRAS of 2, 63 patients (26%) with a GRAS of 3, and 13 patients (5%) with a GRAS of 4. An increasing GRAS score was associated with shortened OS (p < 0.01) and DFS (p < 0.01) after index resection. CONCLUSION: In this retrospective analysis, the cumulative GRAS score effectively stratified OS and DFS after index resection for ACC. Further prospective analysis is required to validate the cumulative GRAS score as a prognostic indicator for clinical use.
BACKGROUND:Adrenocortical carcinoma (ACC) is a rare but aggressive malignancy, and many prognostic factors that influence survival remain undefined. Individually, the GRAS (Grade, Resection status, Age, and Symptoms of hormone hypersecretion) parameters have demonstrated their prognostic value in ACC. This study aimed to assess the value of a cumulative GRAS score as a prognostic indicator after ACC resection. METHODS: A retrospective cohort study of adult patients who underwent surgical resection for ACC between 1993 and 2014 was performed using the United States Adrenocortical Carcinoma Group (US-ACCG) database. A sum GRAS score was calculated for each patient by adding one point each when the criteria were met for tumor grade (Weiss criteria ≥ 3 or Ki67 ≥ 20%), resection status (micro- or macroscopically positive margin), age (≥ 50 years), and preoperative symptoms of hormone hypersecretion (present). Overall survival (OS) and disease-free survival (DFS) by cumulative GRAS score were analyzed by the Kaplan-Meier method and log-rank test. RESULTS: Of the 265 patients in the US-ACCG database, 243 (92%) had sufficient data available to calculate a cumulative GRAS score and were included in this analysis. The 265 patients comprised 23 patients (10%) with a GRAS of 0, 52 patients (21%) with a GRAS of 1, 92 patients (38%) with a GRAS of 2, 63 patients (26%) with a GRAS of 3, and 13 patients (5%) with a GRAS of 4. An increasing GRAS score was associated with shortened OS (p < 0.01) and DFS (p < 0.01) after index resection. CONCLUSION: In this retrospective analysis, the cumulative GRAS score effectively stratified OS and DFS after index resection for ACC. Further prospective analysis is required to validate the cumulative GRAS score as a prognostic indicator for clinical use.
Authors: R Libé; I Borget; C L Ronchi; B Zaggia; M Kroiss; T Kerkhofs; J Bertherat; M Volante; M Quinkler; O Chabre; M Bala; A Tabarin; F Beuschlein; D Vezzosi; T Deutschbein; F Borson-Chazot; I Hermsen; A Stell; C Fottner; S Leboulleux; S Hahner; M Mannelli; A Berruti; H Haak; M Terzolo; M Fassnacht; E Baudin Journal: Ann Oncol Date: 2015-10 Impact factor: 32.976
Authors: Katherine M Prendergast; Paula Marincola Smith; Thuy B Tran; Lauren M Postlewait; Shishir K Maithel; Jason D Prescott; Timothy M Pawlik; Tracy S Wang; Jason Glenn; Ioannis Hatzaras; Rivfka Shenoy; John E Phay; Lawrence A Shirley; Ryan C Fields; Linda X Jin; Sharon M Weber; Ahmed Salem; Jason K Sicklick; Shady Gad; Adam C Yopp; John C Mansour; Quan-Yang Duh; Natalie Seiser; Konstantinos I Votanopoulos; Edward A Levine; George A Poultsides; Carmen C Solórzano; Colleen M Kiernan Journal: Surgery Date: 2019-07-02 Impact factor: 3.982
Authors: Sherita H Golden; Karen A Robinson; Ian Saldanha; Blair Anton; Paul W Ladenson Journal: J Clin Endocrinol Metab Date: 2009-06 Impact factor: 5.958
Authors: Karl Y Bilimoria; Wen T Shen; Dina Elaraj; David J Bentrem; David J Winchester; Electron Kebebew; Cord Sturgeon Journal: Cancer Date: 2008-12-01 Impact factor: 6.860
Authors: Giovanni Lughezzani; Maxine Sun; Paul Perrotte; Claudio Jeldres; Ahmed Alasker; Hendrik Isbarn; Lars Budäus; Shahrokh F Shariat; Giorgio Guazzoni; Francesco Montorsi; Pierre I Karakiewicz Journal: Eur J Cancer Date: 2010-01-13 Impact factor: 9.162
Authors: Paula Marincola Smith; Colleen M Kiernan; Thuy B Tran; Lauren M Postlewait; Shishir K Maithel; Jason Prescott; Timothy Pawlik; Tracy S Wang; Jason Glenn; Ioannis Hatzaras; Rivka Shenoy; John Phay; Lawrence A Shirley; Ryan C Fields; Linda Jin; Sharon Weber; Ahmed Salem; Jason Sicklick; Shady Gad; Adam Yopp; John Mansour; Quan-Yang Duh; Natalie Seiser; Konstantinos Votanopoulos; Edward A Levine; George Poultsides; Carmen C Solórzano Journal: Ann Surg Oncol Date: 2018-06-04 Impact factor: 5.344
Authors: Y S Elhassan; B Altieri; S Berhane; D Cosentini; A Calabrese; M Haissaguerre; D Kastelan; M C B V Fragoso; J Bertherat; A Al Ghuzlan; H Haak; M Boudina; L Canu; P Loli; M Sherlock; O Kimpel; M Laganà; A J Sitch; M Kroiss; W Arlt; M Terzolo; A Berruti; J J Deeks; R Libé; M Fassnacht; C L Ronchi Journal: Eur J Endocrinol Date: 2021-11-30 Impact factor: 6.664
Authors: Jordan J Baechle; David N Hanna; Konjeti R Sekhar; Jeffrey C Rathmell; W Kimryn Rathmell; Naira Baregamian Journal: J Cell Mol Med Date: 2021-10-19 Impact factor: 5.310