A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the US Adrenocortical Carcinoma Study Group

摘要: 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 novel that incorporates LVI to better risk-stratify undergoing resection ACC. METHOD:Patients curative-intent resections ACC from 1993 2014 at 13 institutions comprising the US Group were included. Primary outcome was disease-specific survival (DSS). RESULTS:Of 265 with ACC, 149 included analysis. The current failed differentiate T2 versus T3 disease (p = 0.10). Presence of associated worse DSS no (36 mo vs. 168 mo; p = 0.001). After accounting individual components (size, invasion), remained factor multivariable analysis (hazard ratio 2.14, 95% confidence interval 1.05-4.38, p = 0.04). positivity further stratified (T2: 37 mo median reached; T3: 36 mo 96 mo; p = 0.03) but did influence in T1 or T4 disease. By incorporating LVI, new classification created: [T1: ≤ 5 cm, (-)local (+/-)LVI; T2: > 5 cm, (-)LVI OR any size, (+)local (-)LVI; (+)LVI (+)LVI; T4: (+)adjacent organ (+/-)LVI]. Each progressive group (T1: 167 mo; 37 mo; 15 mo; p < 0.001). CONCLUSIONS:Compared system, proposed which differentiates accurately stratifies If externally validated, this should be considered future staging systems.