ArticleEuropean journal of endocrinology2021
S-GRAS score for prognostic classification of adrenocortical carcinoma: an international, multicenter ENSAT study.
Article in European journal of endocrinology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 1 of them a synthesis that pooled it.
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58 citing papers in PubMed, 1 synthesis or guideline pooled it, 82 citations in OpenAlex.
- Society for Endocrinology Clinical Practice Guideline for the Evaluation of Androgen Excess in Women.Clinical endocrinology · 2025Guideline
- Adjuvant mitotane versus surveillance in low-grade, localised adrenocortical carcinoma (ADIUVO): an international, multicentre, open-label, randomised, phase 3 trial and observational study.The lancet. Diabetes & endocrinology · 2023Trial
- Phase II study of cabazitaxel as second-third line treatment in patients with metastatic adrenocortical carcinoma.ESMO open · 2022Trial
- Clinicopathologic, immunohistochemical, and molecular correlates in resected primary adrenocortical carcinoma: a single-institution cohort study.Virchows Archiv : an international journal of pathology · 2026Article
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- Prognostic role of pretreatment [European journal of nuclear medicine and molecular imaging · 2026Article
- ENPP3 CAR T cells combined with CD206 modulation suppress adrenocortical carcinoma.Journal for immunotherapy of cancer · 2026Article
- Systemic management of adrenal malignancies: adrenocortical carcinoma and pheochromocytoma/paraganglioma.Endocrine connections · 2026Article
- Association of Age with Outcomes in Adrenocortical Carcinoma: A Combined Cancer Registry and Multi-Omic Analysis.Cancers · 2026Article
- Clinicopathologic Determinants of Overall Survival in Adrenocortical Carcinoma: A SEER-Based Population Study.Cancers · 2026Article
- Current clinical management and outcome of patients with adrenal cortical carcinoma (ACC) with rare histological subtypes-an ENSAT cohort study.ESMO open · 2026Observational
- Tailored surgery for large adrenal tumors: the minimally invasive to open (hybrid) approach.Updates in surgery · 2026Article
- Impact of en bloc extended R0 resections on oncological outcome of locally advanced adrenocortical carcinoma.Updates in surgery · 2026Article
- Machine Learning-Driven Identification and In Vitro Validation of the APOBEC3B-ANLN Regulatory Axis in Adrenocortical Carcinoma.Endocrine · 2026Article
- Hope is everything - an hermeneutic phenomenological study on the lived experiences of individuals with adrenocortical carcinoma.Frontiers in endocrinology · 2026Article
- S-GRAS score and the complementary prognostic value of neutrophil-to-lymphocyte ratio in adrenocortical carcinoma: evidence for a synergistic interaction.Frontiers in endocrinology · 2026Observational
- Adrenocortical Mitochondria-Associated Membranes: Isolation, Characterization, and Lipidoproteomic Response to Mitotane.Journal of the Endocrine Society · 2026Article
- A case of immune thrombocytopenia aggravated by therapy for hypercortisolism in adrenocortical carcinoma.Therapeutic advances in endocrinology and metabolism · 2026Article
- Multivisceral Resection for Suspected Adrenocortical Carcinoma.Journal of clinical medicine · 2025Article
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Authors and funding
26 authors at 14 institutions in 9 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveAdrenocortical carcinoma (ACC) has an aggressive but variable clinical course. Prognostic stratification based on the European Network for the Study of Adrenal Tumours stage and Ki67 index is limited. We aimed to demonstrate the prognostic role of a points-based score (S-GRAS) in a large cohort of patients with ACC.
designThis is a multicentre, retrospective study on ACC patients who underwent adrenalectomy.
methodsThe S-GRAS score was calculated as a sum of the following points: tumour stage (1-2 = 0; 3 = 1; 4 = 2), grade (Ki67 index 0-9% = 0; 10-19% = 1; ≥20% = 2 points), resection status (R0 = 0; RX = 1; R1 = 2; R2 = 3), age (<50 years = 0; ≥50 years = 1), symptoms (no = 0; yes = 1), and categorised, generating four groups (0-1, 2-3, 4-5, and 6-9). Endpoints were progression-free survival (PFS) and disease-specific survival (DSS). The discriminative performance of S-GRAS and its components was tested by Harrell's Concordance index (C-index) and Royston-Sauerbrei's R2D statistic.
resultsWe included 942 ACC patients. The S-GRAS score showed superior prognostic performance for both PFS and DSS, with best discrimination obtained using the individual scores (0-9) (C-index = 0.73, R2D = 0.30, and C-index = 0.79, R2D = 0.45, respectively, all P < 0.01vs each component). The superiority of S-GRAS score remained when comparing patients treated or not with adjuvant mitotane (n = 481 vs 314). In particular, the risk of recurrence was significantly reduced as a result of adjuvant mitotane only in patients with S-GRAS 4-5.
conclusionThe prognostic performance of S-GRAS is superior to tumour stage and Ki67 in operated ACC patients, independently from adjuvant mitotane. S-GRAS score provides a new important guide for personalised management of ACC (i.e. radiological surveillance and adjuvant treatment).
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