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

Elliot A. Asare*, Tracy S. Wang, David P. Winchester, Katherine Mallin, Electron Kebebew, Cord Sturgeon

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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. 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 >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. 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 II/III and III/IV ACC. With TNM-A staging, differences in 5-year OS between all stages was significant (I/II [P < .003], II/III [P < .0001], III/IV [P < .0001]). 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.

Original languageEnglish (US)
Pages (from-to)1378-1386
Number of pages9
JournalSurgery (United States)
Volume156
Issue number6
DOIs
StatePublished - Jan 1 2014

Fingerprint

Adrenocortical Carcinoma
Survival
Neoplasm Staging
Neoplasms
Glandular and Epithelial Neoplasms
Proportional Hazards Models
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Asare, Elliot A. ; Wang, Tracy S. ; Winchester, David P. ; Mallin, Katherine ; Kebebew, Electron ; Sturgeon, Cord. / A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease. In: Surgery (United States). 2014 ; Vol. 156, No. 6. pp. 1378-1386.
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abstract = "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. 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 >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. 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 II/III and III/IV ACC. With TNM-A staging, differences in 5-year OS between all stages was significant (I/II [P < .003], II/III [P < .0001], III/IV [P < .0001]). 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.",
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A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease. / Asare, Elliot A.; Wang, Tracy S.; Winchester, David P.; Mallin, Katherine; Kebebew, Electron; Sturgeon, Cord.

In: Surgery (United States), Vol. 156, No. 6, 01.01.2014, p. 1378-1386.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease

AU - Asare, Elliot A.

AU - Wang, Tracy S.

AU - Winchester, David P.

AU - Mallin, Katherine

AU - Kebebew, Electron

AU - Sturgeon, Cord

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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. 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 >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. 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 II/III and III/IV ACC. With TNM-A staging, differences in 5-year OS between all stages was significant (I/II [P < .003], II/III [P < .0001], III/IV [P < .0001]). 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.

AB - 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. 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 >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. 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 II/III and III/IV ACC. With TNM-A staging, differences in 5-year OS between all stages was significant (I/II [P < .003], II/III [P < .0001], III/IV [P < .0001]). 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.

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U2 - 10.1016/j.surg.2014.08.018

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JF - Surgery

SN - 0039-6060

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