ArticleEndocrine pathology2021
Clinical Impact of Pathological Features Including the Ki-67 Labeling Index on Diagnosis and Prognosis of Adult and Pediatric Adrenocortical Tumors.
Article in Endocrine pathology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- The differential diagnosis of adrenocortical tumors: systematic review of Ki-67 and IGF2 and meta-analysis of Ki-67.Reviews in endocrine & metabolic disorders · 2025Pooled it
- Article
- Histopathological and Molecular Characteristics of Pediatric Adrenocortical Tumors: where Do we Stand?Endocrine pathology · 2026Review
- Diagnosis and grading of adrenal cortical carcinoma.Virchows Archiv : an international journal of pathology · 2026Review
- A Rare Case of Interleukin-6-producing Adrenocortical Carcinoma Presenting with a Persistent Fever.Internal medicine (Tokyo, Japan) · 2025Article
- Ki-67 as a Predictor of Metastasis in Adrenocortical Carcinoma: Artificial Intelligence Insights from Retrospective Imaging Data.Journal of clinical medicine · 2025Article
- Management of adrenocortical carcinoma in Slovenia: a real-life analysis of histopathologic markers, treatment patterns, prognostic factors, and survival.Radiology and oncology · 2025Article
- Pediatric Adrenocortical Carcinoma: The Nuts and Bolts of Diagnosis and Treatment and Avenues for Future Discovery.Cancer management and research · 2024Review
- Pediatric Adrenocortical Neoplasms: A Study Comparing Three Histopathological Scoring Systems.Endocrine pathology · 2023Article
- Progress in Adrenal Cortical Neoplasms: From Predictive Histomorphology to FLCN-Driven Germline Pathogenesis and the Prognostic Performance of Multiparameter Scoring Systems in Pediatric Adrenal Cortical Neoplasms.Endocrine pathology · 2023Article
- Diagnostic, Prognostic, and Predictive Role of Ki67 Proliferative Index in Neuroendocrine and Endocrine Neoplasms: Past, Present, and Future.Endocrine pathology · 2023Review
- Case Report: Adrenocortical carcinoma in children-symptoms, diagnosis, and treatment.Frontiers in endocrinology · 2023Review
- Retrospective Analysis of Prognostic Factors in Pediatric Patients with Adrenocortical Tumor from Unique Tertiary Center with Long-Term Follow-Up.Journal of clinical medicine · 2022Review
- Prenatal presentation of an adrenocortical tumor.Cancer reports (Hoboken, N.J.) · 2022Article
- EDP-mitotane in children: reassuring evidence of reversible side-effects and neurotoxicity.Discover oncology · 2022Review
- Adrenocortical carcinoma: Pediatric aspects (Review).Experimental and therapeutic medicine · 2022Review
- Overview of the 2022 WHO Classification of Adrenal Cortical Tumors.Endocrine pathology · 2022Review
- Adjuvant therapy in adrenocortical carcinoma: prognostic factors and treatment options.Endocrine oncology (Bristol, England) · 2022Review
- Prognosis and Therapeutic Efficacy Prediction of Adrenocortical Carcinoma Based on a Necroptosis-Associated Gene Signature.BioMed research international · 2022Article
- Review
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Adrenocortical tumors (ACT) in the adult and pediatric population are generally considered distinct entities due to differences in molecular events related to tumorigenesis, clinical presentation, and outcome. Furthermore, pathological criteria used for diagnosis and prognostication of ACT in adults are usually inadequate for predicting the biological behavior of ACT in children. Here, we analyzed 146 adult and 44 pediatric (< 15y/o) ACT with long-term clinical follow-up and furthered current evidence on the clinical and pathological differences between pediatric and adult tumors. Predilection for female over male gender was observed in both cohorts, but more so in adults (84% vs. 61%, p = 0.003). Cushing syndrome was more frequent in adults (p < 0.001), whereas virilization, either isolated (p < 0.001) or combined to Cushing (p = 0.047), was more common in children. The Ki67 labelling index (LI) of pediatric adenomas and carcinomas was much higher than their corresponding tumors in adults (p < 0.001). Despite these differences, pathological analyses including the evaluation of Ki67 greatly improved patient prognostication in both age cohorts. Indeed, increased Weiss scores and Ki67 indexes correlated with poor overall- and disease-free survival in adult patients with carcinoma. Among the proliferative indexes tested, Ki67 LI ≥ 10% showed the highest hazard ratio (HR) for recurrence and the Ki67 LI ≥ 3% showed the highest HR for survival. In pediatric tumors, the Wieneke score (p < 0.001) and the Ki67 LI (p < 0.001) showed high accuracy for predicting biological behavior, and increased scores/indexes correlated with worse overall and disease-free survival. In this age cohort, Ki67 LI < 10% was able to rule out malignant behavior, whereas Ki67 LI ≥ 15% may be used to predict the patients with higher risks of recurrence and/or poor outcome.
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