[Current TNM classification systems for adrenocortical carcinoma].

Area of Science:

• Oncology
• Endocrinology
• Surgical Pathology

Context:

• Adrenocortical carcinoma (ACC) is a rare and challenging endocrine malignancy.
• The Union for International Cancer Control (UICC) introduced the first TNM staging in 2003.
• Previous staging systems showed limitations in differentiating patient outcomes, particularly for UICC stages II and III.

Purpose:

• To evaluate the efficacy of the European Network for the Study of Adrenal Tumours (ENSAT) staging system for adrenocortical carcinoma (ACC).
• To compare the ENSAT system with the existing UICC TNM classification.
• To recommend an improved staging system for clinical and research applications in ACC.

Summary:

• The ENSAT staging system categorizes ACC into four stages based on tumor size, lymph node involvement, local invasion, venous thrombus, and distant metastasis.
• Analysis of the German ACC Registry and an independent American cohort confirmed the superiority of the ENSAT classification in reflecting patient prognosis.
• The ENSAT system differentiates outcomes more effectively than the UICC classification, especially for stages II and III.

Impact:

• The ENSAT classification provides a more accurate prognostic tool for adrenocortical carcinoma patients.
• Adoption of the ENSAT system is recommended for future clinical practice and research in ACC.
• Accurate documentation of resection status is crucial for optimizing treatment decisions in ACC management.