Predictors of Stojadinovic et al for Disease Specific Survival in Patients with Adrenocortical Carcinoma

 

Parameters:

(1) distant metastasis status

(2) tumor invasion of veins, capsule or adjacent organs

(3) tumor necrosis

(4) mitotic rate

(5) atypical mitosis

(6) overexpression of mdm-2 by immunohistochemistry

 

Parameter	Finding	Points
distant metastasis	absent	0
	present	1
tumor invasion	absent	0
	into veins, capsule and/or adjacent organs	1
tumor necrosis	absent	0
	present	1
mitotic rate in areas with greatest mitotic activity	<= 5 mitoses in 50 high powered fields (HPF)	0
	> 5 mitoses in 50 HPF	1
atypical mitosis	absent	0
	present	1
expression of mdm-2	no overexpression	1
	overexpression present	0

 

where:

• A high powered field indicates use of a 40x objective. An Olympus U-D0 model was used; the area of the field was not stated.

• mdm-2 was from clone 2A10, using a 1:500 diluted, provided by Dr A Levine of Rockefeller University. The staining protocol is given on page 942. Over-expression is defined as > 50% nuclei staining.

• In the original version risk was assigned to overexpression (based on text in column 1 on page 946). However, adrenal cortical carcinomas are mdm-2 negative, so the risk should be assigned to "negative" overexpression.

 

number of risk factors present =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 6

• Disease-specific survival was higher with low numbers of risk factors.

Number of Risk Factors	5 Year Disease Specific Survival
0	not stated
1 or 2	84%
3 or 4	37%
5 or 6	9%

 

Conclusions of the paper:

(1) Predicting prognosis for a patient depends on a meticulous morphologic evaluation, mitotic count and staging of the tumor.

(2) The tumors show a significant molecular complexity and heterogeneity, indicating that targeted therapy needs to be individualized for each patient.

 

Limitations:

• Staining for mdm-2 is likely to be available at only a few centers, at least for the near term. However, the other parameters should be sufficient to determine the relative prognosis for the patient.