Cumulative GRAS Score as a Predictor of Survival After Resection for Adrenocortical Carcinoma: Analysis From the U.S. Adrenocortical Carcinoma Database.

Autor: Baechle JJ; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.; School of Medicine, Meharry Medical College, Nashville, TN, USA., Marincola Smith P; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Solórzano CC; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Tran TB; Department of Surgery, Stanford Medical Center, Stanford, CA, USA., Postlewait LM; Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA., Maithel SK; Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA., Prescott J; Department of Surgery, The Johns Hopkins Medical Center, Baltimore, MD, USA., Pawlik T; Department of Surgery, The Johns Hopkins Medical Center, Baltimore, MD, USA., Wang TS; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA., Glenn J; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA., Hatzaras I; Department of Surgery, New York University Langone Health, New York, NY, USA., Shenoy R; Department of Surgery, New York University Langone Health, New York, NY, USA., Phay JE; Department of Surgery, The Ohio State University, Columbus, OH, USA., Shirley LA; Department of Surgery, The Ohio State University, Columbus, OH, USA., Fields RC; Department of Surgery, Washington University School of Medicine, St Louis, MO, USA., Jin L; Department of Surgery, Washington University School of Medicine, St Louis, MO, USA., Abbott DE; Department of General Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA., Ronnekleiv-Kelly S; Department of General Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA., Sicklick JK; Department of Surgery, University of California San Diego, San Diego, CA, USA., Yopp A; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Mansour J; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Duh QY; Department of Surgery, University of California San Francisco, San Francisco, CA, USA., Seiser N; Department of Surgery, University of California San Francisco, San Francisco, CA, USA., Votanopoulos K; Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA., Levine EA; Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA., Poultsides G; Department of Surgery, Stanford Medical Center, Stanford, CA, USA., Kiernan CM; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. colleen.m.kiernan@vumc.org.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2021 Oct; Vol. 28 (11), pp. 6551-6561. Date of Electronic Publication: 2021 Feb 14.
DOI: 10.1245/s10434-020-09562-8
Abstrakt: 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.
(© 2021. Society of Surgical Oncology.)
Databáze: MEDLINE
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