ASO Author Reflections: Incorporating Lymphovascular Invasion to Improve the Prognostic Reliability of the T-Staging System for Adrenocortical Carcinoma—A Multicenter Study

Excerpt

The 7th edition of the American Joint Committee on Cancer (AJCC) staging system for adrenocortical carcinoma (ACC) does not reliably predict survival outcomes for individual patients.1^–3 This led to the proposal of a new staging system by the European Network for the Study of Adrenal Tumors (ENSAT), which was adapted into the 8th edition staging system.2,4 This new staging system does not modify how T-stage is defined, but rather minimizes its influence and redistributes patients based on their nodal status and the presence of metastatic disease. Relying on nodal status, however, can be problematic, as there is typically a low lymph node yield during surgical resection of ACC.5 Lymphovascular invasion (LVI) is a pathologic variable that is routinely reported for all resected adrenal tumors, and has been demonstrated to be an independent prognostic indicator for many other cancers. Our study sought to investigate whether incorporating LVI into the current T-staging system for ACC could better discriminate patient outcomes for disease-specific survival (DSS).6 …