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Editorial Comments on “Research Landscape on Adrenocortical Carcinoma Over Four Decades”
Alok Singh1,2 (D | Sudip Bhattacharya3 D
1Department of Naturopathy & Yogic Sciences, Faculty of Naturopathy and Yogic Sciences, SGT University, Gurugram, 122505, Haryana,
India | 2Department of Community Medicine, Faculty of Medicine and Health Sciences, SGT University, Gurugram, Haryana, India | 3Department of Community and Family Medicine, All India Institutes of Medical Sciences, Deoghar, 815142, Jharkhand, India
Correspondence: Alok Singh (alokiiphd@gmail.com)
Received: 14 May 2025 | Accepted: 19 May 2025
Dear Editor,
Chu et al. present a well-executed bibliometric study on the global research output concerning adrenocortical carcinoma (ACC), a rare and aggressive endocrine malignancy. The authors effec- tively trace publication trends, highlight geographic disparities, and use co-occurrence mapping to identify thematic research clusters. Their use of three major databases (Scopus, PubMed, and Web of Science) and visualization through VOSviewer is methodologically sound. However, several research gaps-ab- sent not only in the results but also in the stated objectives- warrant attention for a more comprehensive roadmap [1].
First, although the authors aim to “outline academic output and trends,” they do not explicitly seek to examine the evidence hi- erarchy within this literature. There is no stratification by study type (e.g., randomized trials vs. case series) or assessment of how much of the publication volume translates into high-level clini- cal evidence. Including an objective to map clinical trial density, design, and progression over time would have added critical in- sight into whether growing publication numbers have truly ad- vanced treatment paradigms. Second, the study does not include diagnostic science in its thematic scope. Although genetic and molecular clusters are identified, emerging diagnostics-includ- ing advanced imaging (e.g., PET tracers), liquid biopsy, machine learning-based histopathology, or hormonal assay innovations- are not captured. A bibliometric focus on diagnostic evolution could have better addressed clinical challenges in early detec- tion and differentiation of ACC from adenomas. Third, although the authors mention global output and institutional networks, the role of health systems and policy research is omitted. There is no mention of keywords or publications focused on barriers to care, delays in diagnosis, access to specialized surgical services,
or national cancer control planning. These topics are especially crucial in the context of a rare cancer, where system-level ineffi- ciencies can be fatal. Expanding the study’s objective to include health services and delivery science would significantly en- hance its applicability. Fourth, the psychosocial impact of ACC is entirely absent. There is no mention of studies on quality of life, mental health, caregiver strain, or survivorship, despite the debilitating effects of hormone excess, repeated surgeries, and lifelong mitotane therapy. The omission of such keywords in the co-occurrence map reflects a deeper issue-lack of integration between oncology and psycho-oncology research. A future bib- liometric study with explicit objectives to track psychosocial lit- erature would help define patient-centered care priorities. Fifth, the study misses the opportunity to explore comparative effec- tiveness and health economics. This is notable given the use of costly therapies such as mitotane, immunotherapy, and targeted agents. Without analyzing literature on cost-effectiveness, ad- herence, and real-world effectiveness, bibliometric studies risk overrepresenting innovation without assessing utility. Future objectives should include economic and implementation sci- ence themes. Finally, ethical and legal aspects of ACC research are unaddressed. With the rise of germline genetic testing and AI-based diagnostics, issues of data privacy, familial risk disclo- sure, and consent frameworks are increasingly relevant but not explored. A more holistic bibliometric goal should incorporate this domain.
In conclusion, this bibliometric analysis provides founda- tional insight into ACC research trends but omits several cru- cial dimensions that could enrich its objectives and utility. Incorporating themes such as diagnostics, systems science, psy- chosocial outcomes, cost-effectiveness, and research ethics in
@ 2025 The Japanese Urological Association.
future analyses will create a more integrated research vision for this devastating disease.
Conflicts of Interest
The authors declare no conflicts of interest.
Reference
1. T. P. Chu, C. Y. Kuo, and S. P. Cheng, “Research Landscape on Adrenocortical Carcinoma Over Four Decades,” International Journal of Urology 32, no. 9 (2025): 1172-1177.