The clinical utility of ‘GRAS’ parameters in stage I–III adrenocortical carcinomas: long-term data from a high-volume institution

Background Adrenocortical carcinoma (ACC) is a rare cancer with poor survival. We sought to identify prognostic factors and assess its clinical utility in postoperative management of nonmetastatic ACC. Methods We included 65 patients who underwent adrenalectomy and clinicopathological diagnosed as European Network for the Study of Adrenal Tumors (ENSAT) stage I–III ACC in our center from 2009 to 2017. Potential clinicopathological parameters were selected. The prognostic correlation, including overall survival (OS) and recurrence-free survival (RFS), was analyzed using Kaplan–Meier method and univariate and multivariate Cox model. Results The 2-year and 5-year post-surgery survival rate were 54.6% (95%CI: 42.5–70.1%) and 33.5% (95%CI: 22.3–50.6%), respectively. 46 (70.8%) cases were symptomatic ACC. Tumor-related or hormone-related symptom was identified as independent prognostic factor in OS (HR = 5.5, 95%CI: 1.87–16.16) and RFS (HR = 3.62, 95%CI: 1.28–10.24). Higher tumor grade (Weiss score > 6 or Ki67 index ≥ 20%) was independently associated with poor OS (HR = 4.73, 95%CI: 2.15–10.43). R status (R1/R2/Rx) was independently correlated with worse RFS (HR = 2.56, 95%CI:1.21–5.43). Accordingly, patients with higher GRAS (Grade, R status, age, and symptoms) score were more likely to have poor prognosis (OS: HR = 2.7, 95%CI: 1.43–5.11 and RFS: HR = 3.31, 95%CI: 1.68–6.52, respectively). Conclusions Symptoms, higher tumor grade and positive/unknown R status were independent risk factors in stage I–III ACC. Comprehensive consideration of GRAS parameters may optimize the prognostic assessment for postoperative patients.