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Inflammation-based score in pediatric adrenocortical carcinoma
Insights
Inflammation-based scores show prognostic value in pediatric adrenocortical carcinoma (pACC). Monocyte-to-lymphocyte ratio (MLR) and advanced tumor stage are key indicators of unfavorable outcomes in pACC patients.
Area of Science:
- Pediatric Oncology
- Cancer Prognostics
- Inflammatory Markers
Background:
- Inflammation-based scores are established prognostic factors in adult adrenocortical carcinoma (ACC).
- The prognostic utility of these scores in pediatric ACC (pACC) remains underexplored.
- Understanding prognostic indicators is crucial for tailoring treatment strategies in pACC.
Purpose of the Study:
- To evaluate the prognostic significance of pretreatment inflammation-based scores in pediatric adrenocortical carcinoma (pACC).
- To identify key predictors of overall survival (OS) in pACC patients.
- To explore the role of neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and serum albumin.
Main Methods:
- International multicenter analysis of 129 pediatric patients diagnosed with ACC.
- Analysis of pretreatment inflammation-based scores (NLR, dNLR, PLR, MLR, albumin) and clinical parameters.
- Primary endpoint: 10-year overall survival (OS); statistical analysis included univariable and multivariable adjustments.
Main Results:
- Univariable analysis revealed significant associations between elevated NLR, MLR, PLR, dNLR, younger age, advanced tumor stage (IV), and incomplete resection with reduced 10-year OS.
- Multivariable analysis identified advanced tumor stage IV (HR 336.7) and MLR ≥0.28 (HR 247.1) as independent predictors of unfavorable outcomes.
- 27 out of 102 patients died from the disease during the follow-up period.
Conclusions:
- Inflammation-based scores, particularly MLR, demonstrate prognostic value in pediatric adrenocortical carcinoma.
- Advanced tumor stage and elevated MLR are significant indicators of poor prognosis in pACC.
- Further validation in larger cohorts is warranted to establish these scores as reliable prognostic tools in pACC.
Abstract:
Inflammation-based scores have been demonstrated to be independent prognostic factors in predicting outcomes in adult adrenocortical carcinoma (ACC). We aimed to investigate the prognostic role of these scores in pediatric adrenocortical carcinoma (pACC) patients. An international multicenter analysis was conducted on a pediatric cohort from 21 ACC centers. Pretreatment inflammation-based scoring parameters, including neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and serum albumin, as well as clinical parameters, were analyzed. The primary endpoint was 10-year overall survival (OS). One hundred twenty-nine pediatric patients (50.4% females, mean age 87 months) across all tumor stages with a median follow-up of 36 months were included. 107/108 patients underwent primary surgery, and 62/106 received systemic treatment at the time of diagnosis. Of 102 patients, 27 died from disease. In the univariable analysis, NLR ≥5 (HR 8.0, 95% CI 3.4-19.1), MLR ≥0.28 (HR 4.2, 95% CI 1.7-10.4), PLR ≥190 (HR 4.5, 95% CI 2.0-10.4) and dNLR ≥1.44 (HR 5.9, 95% CI 2.3-15.5), as well as clinical parameters age ≥4 years (HR 5.5, 95% CI 1.9-15.8), tumor stage IV (HR 5.7, 95% CI 2.7-11.9) and incomplete resection status (HR 8.0, 95% CI 3.6-17.7) were significantly associated with reduced 10-year OS. After multivariable adjustment, only tumor stage IV (HR 336.7, 95% CI 5.8-19,518.1) and MLR ≥0.28 (HR 247.1, 95% CI = 3.1-19,907.5) were significantly associated with an unfavorable outcome. Inflammation-based scores tend to have prognostic value in pACC and could serve as prognostic tools after further validation in future studies with sufficient case numbers.
