Endocrinol Metab (Seoul). 2024;39(5):803-812.

The Modified S-GRAS Scoring System for Prognosis in Korean with Adrenocortical Carcinoma.

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제1저자 백선경, 이승훈 · 교신저자 김정희

PMID 39322187 PMC11525693 DOI 10.3803/EnM.2024.2086 IF 5.1 내분비대사내과

소속 (10)

Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Lunit, Seoul, Korea.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGRUOUND Adrenocortical carcinomas (ACCs) are rare tumors with aggressive but varied prognosis. Stage, Grade, Resection status, Age, Symptoms (S-GRAS) score, based on clinical and pathological factors, was found to best stratify the prognosis of European ACC patients. This study assessed the prognostic performance of modified S-GRAS (mS-GRAS) scores including modified grade (mG) by integrating mitotic counts into the Ki67 index (original grade), in Korean ACC patients.

METHODS Patients who underwent surgery for ACC between January 1996 and December 2022 at three medical centers in Korea were retrospectively analyzed. mS-GRAS scores were calculated based on tumor stage, mG (Ki67 index or mitotic counts), resection status, age, and symptoms. Patients were divided into four groups (0-1, 2-3, 4-5, and 6-9 points) based on total mS-GRAS score. The associations of each variable and mS-GRAS score with recurrence and survival were evaluated using Cox regression analysis, Harrell's concordance index (C-index), and the Kaplan-Meier method.

RESULTS Data on mS-GRAS components were available for 114 of the 153 patients who underwent surgery for ACC. These 114 patients had recurrence and death rates of 61.4% and 48.2%, respectively. mS-GRAS score was a significantly better predictor of recurrence (C-index=0.829) and death (C-index=0.747) than each component (P<0.05), except for resection status. mS-GRAS scores correlated with shorter progression-free survival (P=8.34E-24) and overall survival (P=2.72E-13).

CONCLUSION mS-GRAS scores showed better prognostic performance than tumor stage and grade in Asian patients who underwent surgery for ACC.

Keywords

Adrenocortical carcinomaPrognosisRecurrenceSurvival analysis

Figures

**Fig. 1.** Kaplan–Meier analyses of (A) progression-free survival and (B) overall survival according to modified Stage, Grade, Resection status, Age, Symptom (mS-GRAS) score grouping in patients with adrenocortical carcinoma who underwent adrenalectomy (n=114). Components of the mS-GRAS score included European Network for the Study of Adrenal Tumour (ENSAT) stage (S), modified grading (modified G), resection status (R), age (A), and tumor- or hormone-related symptoms (S).

그림 출처: PubMed Central 공개 논문 (PMC11525693)

Conflict of interest statement

CONFLICTS OF INTEREST . Chang Ho Ahn in Lunit as a medical director and has a stock option in the firm. Jung Hee Kim is a deputy editor of the journal. But she was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

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