Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, T6G 1Z2, Canada.
J Endocrinol Invest. 2022 Jan;45(1):89-94. doi: 10.1007/s40618-021-01618-0. Epub 2021 Jun 25.
To evaluate the performance characteristics of AJCC 7th and 8th staging systems among patients with adrenal cortical carcinoma.
Surveillance, Epidemiology, and End Results (SEER) 18-registry was accessed and patients with adrenocortical carcinoma who were diagnosed 2010-2015 with complete information about AJCC 7th staging system were included. AJCC 8th staging system information was then reconstructed for each patient using available TNM staging variables. Kaplan-Meier overall survival estimates, multivariable Cox regression analysis, and concordance index (C-statistic) were used to examine the performance characteristics of both staging systems.
A total of 574 patients with a diagnosis of adrenocortical carcinoma were included in the current analysis. Using Kaplan-Meier survival estimates, overall survival was compared among different AJCC stages for both versions; and the P value was significant (< 0.001) for both comparisons. C-statistic was then calculated for both staging systems and the results were as follows: for AJCC 7th version: 0.726 (95% CI 0.683-0.769); and for AJCC 8th version: 0.745 (95% CI 0.704-0.786). Patients with M1 disease (stage IV according to AJCC 8th edition) were then divided according to the extent of distant metastases into single versus multiple sites of metastases. Using Kaplan-Meier survival estimates, patients with a single site of metastases have better overall survival (P = 0.006). A C-statistic for a hypothetical modification of AJCC 8th staging system subdividing stage IV patients into IVA and IVB based on the number of metastatic sites was: 0.753 (95% CI 0.713-0.794).
There is a minimal difference in the prognostic performance between both versions of the AJCC staging system. Subdivision of stage IV cancer into stage IVA and IVB (according to the number of organs with metastatic deposits) should be considered in subsequent versions of adrenocortical carcinoma staging.
评估 AJCC 第 7 版和第 8 版分期系统在肾上腺皮质癌患者中的表现特征。
访问监测、流行病学和最终结果（SEER）18 数据库，纳入 2010-2015 年期间诊断为肾上腺皮质癌且 AJCC 第 7 版分期系统完整信息的患者。然后，使用可用的 TNM 分期变量为每位患者重建 AJCC 第 8 版分期系统信息。使用 Kaplan-Meier 总生存估计、多变量 Cox 回归分析和一致性指数（C 统计量）来检验两种分期系统的表现特征。
共有 574 例肾上腺皮质癌患者纳入本分析。使用 Kaplan-Meier 生存估计，比较了两种版本 AJCC 分期之间的总生存情况，并且两种比较的 P 值均有统计学意义（<0.001）。然后计算了两种分期系统的 C 统计量，结果如下：对于 AJCC 第 7 版：0.726（95%置信区间 0.683-0.769）；对于 AJCC 第 8 版：0.745（95%置信区间 0.704-0.786）。然后根据远处转移的范围将 AJCC 第 8 版 M1 期（IV 期）患者分为单发和多发转移部位。使用 Kaplan-Meier 生存估计，具有单一转移部位的患者总生存情况更好（P=0.006）。基于转移部位数量将 AJCC 第 8 版分期系统中的 IV 期患者分为 IVA 和 IVB 的假设修改后的 AJCC 第 8 版分期系统的 C 统计量为：0.753（95%置信区间 0.713-0.794）。
两种 AJCC 分期系统的预后表现特征差异很小。应考虑在后续的肾上腺皮质癌分期版本中，将 IV 期癌症分为 IVA 和 IVB（根据有转移灶的器官数量）。
