ArticleEndocrine pathology2023
Prognostic Value of Microscopic Tumor Necrosis in Adrenal Cortical Carcinoma.
Article in Endocrine pathology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 11 citations in OpenAlex.
- Clinicopathologic, immunohistochemical, and molecular correlates in resected primary adrenocortical carcinoma: a single-institution cohort study.Virchows Archiv : an international journal of pathology · 2026Article
- 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
- Tumor necrosis, an independent prognostic factor for predicting gastric gastrointestinal stromal tumors.Journal of gastrointestinal oncology · 2025Article
- Management of adrenocortical carcinoma in Slovenia: a real-life analysis of histopathologic markers, treatment patterns, prognostic factors, and survival.Radiology and oncology · 2025Article
- Differences in life expectancy of adrenocortical carcinoma patients vs. age‑ and sex-matched population controls.International urology and nephrology · 2025Article
- High Filamin a Expression in Adrenocortical Carcinomas Is Associated with a Favourable Tumour Behaviour: A European Multicentric Study.International journal of molecular sciences · 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
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Authors and funding
12 authors at 4 institutions in 3 countries.
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Abstract
Adrenal cortical carcinoma (ACC) is an uncommon neoplasm with variable prognosis. Several histologic criteria have been identified as predictors of malignancy in adrenal cortical tumors. The Weiss score is the system most widely employed for diagnostic purposes, but also possesses prognostic value. We aim to determine the relative impact of each Weiss parameter on ACC patient survival. A multicenter retrospective analysis was conducted on a series of 79 conventional ACCs surgically treated at the Florence and Utrecht centers of the European Network for the Study of Adrenal Tumors (ENSAT). Weiss classification was recapitulated using principal component analysis (PCA). The Kaplan-Meier and Cox multivariate regression analyses were applied in order to estimate the prognostic power of Weiss versus other clinical parameters. PCA reduced the nine Weiss parameters to the best fitting 4-component model, each parameter clustering with a single component. Necrosis and venous invasion clustered together with the highest scores, thus establishing the most relevant component (Component 1) to explain Weiss distribution variability. Only Component 1 significantly predicted overall survival (OS, log-rank = 0.008) and disease-free survival (DFS, log-rank < 0.001). When considering the prognostic power of Weiss parameters, necrosis alone could independently assess OS (log-rank = 0.004) and DFS (log-rank < 0.001) at both the Kaplan-Meier and multivariate Cox regression analyses [hazard ratio (HR) = 7.8, 95% confidence interval [CI] = 1.0-63.5, p = 0.05, and HR = 12.2, 95% CI = 1.6-95.0, p = 0.017, respectively]. The presence of necrosis significantly shortened time to survival (TtS) and time to recurrence (TtR), 57.5 [31.5-103.5] vs 34 [12-78] months (p = 0.05) and 57.5 [31.5-103.5] vs 7 [1.0-31.5] months (p < 0.001), respectively. Our study suggests that, of the Weiss parameters, necrosis is the most powerful adverse factor and the best predictor of OS and DFS in ACC patients.
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