Inflammation-based score in pediatric adrenocortical carcinoma

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.