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ASO Author Reflections: The Impact of Oncocytic Histology on Survival in Adrenocortical Carcinoma
Aditya S. Shirali, MD , and Paul H. Graham, MD
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
PAST
The past two decades have seen a significant evolution of the understanding of the biological behavior of onco- cytic adrenocortical neoplasms (OAN). The Lin-Weiss- Bisceglia (LWB) criteria provided a standardized approach for evaluating OAN and differentiating this subtype from conventional adrenal neoplasms.1 Contemporary views of oncocytic adrenocortical carcinomas (OACs) suggest a more indolent manner compared with conventional ACCs (ACCs) with improved overall survival despite their overall larger tumor size at presentation.2,3 However, studies highlighting a survival benefit of the oncocytic histology have been limited by small sample sizes, varying histologic and clinical practice patterns, or the use of mixed oncocytic tumor types.
PRESENT
To further the knowledge of this rare subtype, we per- formed the largest single-institutional study to compare the clinical presentation, treatment, and outcomes of patients with OANs with specific emphasis on comparing outcomes of pure OACs with conventional ACCs.2-4 We identified and reviewed the cancer-related outcomes of 41 OANs and 214 ACCs treated and followed at the University of Texas MD Anderson Cancer Center over a 30-year period.4 Among patients with OANs, we found that those with OAC histology were more likely to have a shorter disease-free
survival (DFS) and overall survival (OS) compared with other oncocytic histologies. Interestingly, patients with OACs had improved OS compared to those with ACCs, but no difference in DFS. After a 2:1 matched cohort analysis was performed specifically matching for patient age, patient sex, American Joint Committee on Cancer stage, and tumor functionality, no statistically significant differ- ences in DFS or OS were observed between the two cohorts. These findings are in contrast to earlier studies that suggested an improved OS among oncocytic adrenocortical tumors when compared with conventional ACCs.2,3 Com- paring differences in DFS and OS between the studies is challenging, given differences in included mitotic rates, proliferative indices, and percent oncocytic histology in the specimens. While the role of morphologic and immuno- histochemical criteria for prognosticating OANs, and specifically OACs, remains to be investigated, it is appar- ent that factors beyond oncocytic histology itself are important in the prognosis of patients with adrenocortical carcinoma.
FUTURE
Prognostication of OACs continues to remain a chal- lenge owing to the rarity of the pathology and the changes in histologic diagnosis and pathologic reporting over time. While morphologic criteria and proliferative indices are one of several methods of identifying aggressive tumor biology, genome-wide and targeted studies of molecular markers may serve as the next step in improving prognostic stratification in all subtypes of ACC.5,6 Additionally, the use of liquid biopsy may represent a promising tool in the prognostication and guidance of treatment strategies in patients with ACC. In the interim, multi-institutional col- laborations to consolidate adrenal databases and tumor banks may help provide the power necessary for improved outcomes analysis of this rare disease.
@ Society of Surgical Oncology 2022
Accepted: 21 February 2022
Published Online: 10 May 2022
P. H. Graham, MD e-mail: phgraham@mdanderson.org
DISCLOSURE The authors have no conflicts of interest to disclose.
REFERENCES
1. Bisceglia M, Ludovico O, Di Mattia A, et al. Adrenocortical oncocytic tumors: report of 10 cases and review of the literature. Int J Surg Pathol. 2004;12(3):231-43.
2. Mills JK, Khalil M, Pasieka J, Kong S, Xu Y, Harvey A. Oncocytic subtypes of adrenal cortical carcinoma: aggressive in appearance yet more indolent in behavior? Surgery. 2019;166(4):524-33.
3. Renaudin K, Smati S, Wargny M, et al. Clinicopathological description of 43 oncocytic adrenocortical tumors: importance of Ki-67 in histoprognostic evaluation. Mod Pathol. 2018;31(11):1708-16.
4. Wong DD, Spagnolo DV, Bisceglia M, Havlat M, McCallum D, Platten MA. Oncocytic adrenocortical neoplasms-a clinicopatho- logic study of 13 new cases emphasizing the importance of their recognition. Hum Pathol. 2011;42(4):489-99.
5. Shirali AS, Zagzag J, Chiang YJ, et al. Differences in the clinicopathologic behavior of oncocytic adrenocortical neoplasms and conventional adrenocortical carcinomas. Ann Surg Oncol. 2022. https://doi.org/10.1245/s10434-022-11626-w
6. Lippert J, Fassnacht M, Ronchi CL. The role of molecular profiling in adrenocortical carcinoma. Clin Endocrinol (Oxf). 2021. https://d oi.org/10.1111/cen.14629.
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