A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease

作者：Asare Elliot A^*; Wang Tracy S; Winchester David P; Mallin Katherine; Kebebew Electron; Sturgeon Cord

来源：Surgery, 2014, 156(6): 1378-1386.

DOI：10.1016/j.surg.2014.08.018

Background. Current American Joint Committee on Cancer/International Union against Cancer (AJCC/UICC) and European Network for the Study of Adrenal Tumors staging for adrenocortical carcinoma (ACC) have not shown a survival difference between patients with stage I/II disease. This study evaluates current staging systems for survival prediction using a larger cohort and assesses whether incorporating age into ACC staging improves survival predictions. %26lt;br%26gt;Methods. Patients in the National Cancer Data Base (1985-2006) with a diagnosis of ACC were identified and staged using a novel TNM-A staging system: Stage I (T1/T2N0M0, age -55), stage II (T1/T2N0M0, age %26lt;= 55), stage III (T1/T2N1M0 or T3/T4N0-N1M0, any age), or stage IV (any T any NM1, any age). Differences in overall survival (OS) by stage were compared using a Cox proportional hazards model. %26lt;br%26gt;Results. Staging was derived for 1,579 of 3,262 patients. Median age was 54 years; mean tumor size was 11.6 cm. Using current staging, differences in 5-year OS was observed only between patients with stages and III/IV ACC. With TNM-A staging, differences in 5-year OS between all stages was significant (I/II [P %26lt; .003], II/III [P %26lt; .0001], III/IV [P %26lt; .0001]). %26lt;br%26gt;Conclusion. A staging system that incorporates patient age better predicts 5-year OS among patients with stages I/II ACC. Consideration should be given to including age in staging for ACC, because it may better inform providers about treatment and prognosis.

• 出版日期2014-12
• 单位西北大学