title: A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease.
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]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: American Joint Committee on Cancer (AJCC), Chicago, IL; Cancer Programs, American College of Surgeons, Chicago, IL; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: easare@facs.org.
authors.forename: Elliot A
authors.initials: EA
authors.lastname: Asare
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Wang
authors.affiliation: Cancer Programs, American College of Surgeons, Chicago, IL.
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.affiliation: Cancer Programs, American College of Surgeons, Chicago, IL.
authors.forename: Katherine
authors.initials: K
authors.lastname: Mallin
authors.affiliation: Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Cord
authors.initials: C
authors.lastname: Sturgeon
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D018268:Adrenocortical Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging / Q000145:classification*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult