Evidence map›Paper›PMID 29164414›Full record

ArticleAnnals of surgical oncology2018

A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the US Adrenocortical Carcinoma Study Group.

Caroline E Poorman, Cecilia G Ethun, Lauren M Postlewait, Thuy B Tran, Jason D Prescott, Timothy M Pawlik, Tracy S Wang, Jason Glenn, Ioannis Hatzaras, Rivfka Shenoy and 19 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
2.5field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 19 citations in OpenAlex.

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  7. Advances in adrenal tumors 2018.Endocrine-related cancer · 2018
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

29 authors at 15 institutions in 1 country.

Caroline E PoormanDivision of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Cecilia G EthunDivision of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Lauren M PostlewaitDivision of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Thuy B TranDepartment of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Jason D PrescottDepartment of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Timothy M PawlikDepartment of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Tracy S WangDepartment of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Jason GlennDepartment of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Ioannis HatzarasDepartment of Surgery, New York University School of Medicine, New York, NY, USA.
Rivfka ShenoyDepartment of Surgery, New York University School of Medicine, New York, NY, USA.
John E PhayDepartment of Surgery, The Ohio State University, Columbus, OH, USA.
Kara KeplingerDepartment of Surgery, The Ohio State University, Columbus, OH, USA.
Ryan C FieldsDepartment of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Linda X JinDepartment of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Sharon M WeberDepartment of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Ahmed SalemDepartment of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Jason K SicklickDepartment of Surgery, University of California San Diego, San Diego, CA, USA.
Shady GadDepartment of Surgery, University of California San Diego, San Diego, CA, USA.
Adam C YoppDepartment of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
John C MansourDepartment of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Quan-Yang DuhDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Natalie SeiserDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Carmen C SolórzanoDepartment of Surgery, Vanderbilt University, Nashville, TE, USA.
Colleen M KiernanDepartment of Surgery, Vanderbilt University, Nashville, TE, USA.
Konstantinos I VotanopoulosDepartment of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Edward A LevineDepartment of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Charles A StaleyDivision of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
George A PoultsidesDepartment of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Shishir K MaithelDivision of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. smaithe@emory.edu.
Emory University · USMedical College of Wisconsin · USNew York University · USStanford University · USThe Ohio State University · USThe University of Texas Southwestern Medical Center · USUniversity of California, San Diego · USUniversity of California, San Francisco · USUniversity of Wisconsin–Madison · USVanderbilt University · USWake Forest University · USWashington University in St. Louis · USJohns Hopkins Medicine · USJohns Hopkins University · USWinship Cancer Institute

Funding

Translational Therapeutics Research Program (TT)P30CA016058 · NCI · OHIO STATE UNIVERSITY · PI Tasleem J Padamsee · 1985 to 2026
$132.3M
Novel Allosteric Kinase Inhibitors Target Imatinib-Resistant GISTK08CA168999 · NCI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI SICKLICK, JASON KEITH · 2014 to 2018
$888k
NCI NIH HHS K08 CA168999NCI NIH HHS P30 CA016058
6 · The paper itself

Abstract

backgroundThe 7th AJCC T-stage system for adrenocortical carcinoma (ACC), based on size and extra-adrenal invasion, does not adequately stratify patients by survival. Lymphovascular invasion (LVI) is a known poor prognostic factor. We propose a novel T-stage system that incorporates LVI to better risk-stratify patients undergoing resection for ACC.

methodPatients undergoing curative-intent resections for ACC from 1993 to 2014 at 13 institutions comprising the US ACC Group were included. Primary outcome was disease-specific survival (DSS).

resultsOf the 265 patients with ACC, 149 were included for analysis. The current T-stage system failed to differentiate patients with T2 versus T3 disease (p = 0.10). Presence of LVI was associated with worse DSS versus no LVI (36 mo vs. 168 mo; p = 0.001). After accounting for the individual components of the current T-stage system (size, extra-adrenal invasion), LVI remained a poor prognostic factor on multivariable analysis (hazard ratio 2.14, 95% confidence interval 1.05-4.38, p = 0.04). LVI positivity further stratified patients with T2 and T3 disease (T2: 37 mo vs. median not reached; T3: 36 mo vs. 96 mo; p = 0.03) but did not influence survival in patients with T1 or T4 disease. By incorporating LVI, a new T-stage classification system was created: [T1: ≤ 5 cm, (-)local invasion, (+/-)LVI; T2: > 5 cm, (-)local invasion, (-)LVI OR any size, (+)local invasion, (-)LVI; T3: > 5 cm, (-)local invasion, (+)LVI OR any size, (+)local invasion, (+)LVI; T4: any size, (+)adjacent organ invasion, (+/-)LVI]. Each progressive new T-stage group was associated with worse median DSS (T1: 167 mo; T2: 96 mo; T3: 37 mo; T4: 15 mo; p < 0.001).

conclusionsCompared with the current T-stage system, the proposed T-stage system, which incorporates LVI, better differentiates T2 and T3 disease and accurately stratifies patients by disease-specific survival. If externally validated, this T-stage classification should be considered for future AJCC staging systems.

Indexed as

Adrenal Cortex NeoplasmsAdrenalectomyAdrenocortical CarcinomaFemaleFollow-Up StudiesHumansLymphatic MetastasisMaleMiddle AgedNeoplasm InvasivenessNeoplasm StagingRetrospective StudiesRisk FactorsSurvival RateTreatment OutcomeTumor Burden

Identifiers

PMID29164414
PMCPMC6087546
OpenAlexW2599462460

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.