Exp Clin Endocrinol Diabetes 2013; 121 - OP8_49
DOI: 10.1055/s-0033-1336658

Prognostic value of histological markers in localized adrenocortical carcinoma after complete resection

F Beuschlein 1, J Obracay 2, W Saeger 3, M Reincke 4, R Libe 5, 6, P Lolli 7, M Terzolo 8, B Allolio 2, HH Müller 9, M Fassnacht 2
  • 1University of Munich, Medizinische Klinik und Poliklinik IV, München, Germany
  • 2University of Würzburg, Würzburg, Germany
  • 3Marienkrankenhaus Hamburg, Hamburg, Germany
  • 4University of Munich, München, Germany
  • 5Cochin Hospital, Paris, France
  • 6Institut Gustave Roussy, Paris, France
  • 7Ospedale Niguarda Cà Granda, Milano, Italy
  • 8Medicina Interna I, Orbassano, Italy
  • 9Institute for Medical Biometry, Munich, Germany

Purpose: Recurrence of adrenocortical cancer (ACC) even after complete resection is a common clinical problem. The aim of this study was the identification of histological parameters with potential prognostic value.

Patients and methods: From the German ACC registry 318 patients with ENSAT stage I-III were identified with R0 resection for whom histological analysis was available. Histological markers were correlated with recurrence free and overall survival. As an independent validation cohort 250 patients from six European centers were utilized.

Results: Within the German cohort, univariate analysis identified age at diagnosis, tumor size and lymph node positivity as markers with predictive value for recurrence free survival (RFS). Accordingly, ENSAT staging was also of significance (p = 0.02). Ki67 index provided the single best prognostic value for recurrence free survival (HR 1.042 per % increase for the German cohort and HR 1.024 for the validation cohort; p < 0.001) which was superior to markers evaluated for calculation of the Weiss score. Following multivariate analysis including age, tumor size and adjuvant mitotane treatment Ki67 index remained informative. Similar results were obtainable for overall survival (HR 1.051 per % increase for the German cohort and HR 1.023 for the validation cohort; p < 0.001).

Conclusion: In conclusion, Ki67 was identified as the single most important prognostic marker for disease recurrence in ACC patients following R0 resection. Our findings will help to guide decisions on adjuvant therapy for this rare disease.