{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:57:41Z","timestamp":1787313461646,"version":"build-2736575974"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T00:00:00Z","timestamp":1677196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The prognostic stratification of the current AJCC\/UICC TNM classification\n                    for adrenocortical carcinoma (ACC) has been validated in only a few studies. In\n                    this study, it was hypothesized that redefining the T category cut-off would\n                    result in a significant improvement in estimated stage-related survival. In 935\n                    patients with ACC from the SEER database, optimal cut-off values based on tumor\n                    size were first determined to redefine T1 and T2 categories. Cox proportional\n                    hazards regression analysis and receiver operating characteristics (ROC) were\n                    then used to determine the prognostic value of the revised version. A new\n                    cut-off value of 9.5\u2009cm tumor size was established to differentiate\n                    between T1 and T2 tumors, leading to a revised TNM classification. As a result,\n                    a more homogeneous distribution of patients with ACC across all stages was\n                    observed. Notably, the predictive value of the newly proposed TNM classification\n                    in the ROC analysis exceeded that of the 7th and 8th editions of the\n                    AJCC\/UICC classification system. Finally, the prognostic superiority of\n                    the revised TNM classification was confirmed in a multivariate Cox proportional\n                    hazards regression model. In conclusion, the present study demonstrates that\n                    updating the current staging system with revised T1 and T2 categories\n                    significantly improves the prediction of cancer-specific survival (CSS) in\n                    patients with ACC.<\/jats:p>","DOI":"10.1055\/a-2042-2431","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T19:08:56Z","timestamp":1677265736000},"page":"227-235","source":"Crossref","is-referenced-by-count":6,"title":["A Revised Version of the TNM Classification Leads to Optimized\n                    Predictive Performance in Patients with Adrenocortical Carcinoma"],"prefix":"10.1055","volume":"55","author":[{"given":"Stephan Oliver","family":"David","sequence":"first","affiliation":[{"name":"Department of Surgery (A), Heinrich-Heine-University and University\n                    Hospital Duesseldorf, Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Krieg","sequence":"first","affiliation":[{"name":"Clinic for Gastroenterology, Hepatology and Infectious Diseases,\n                    Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Esposito","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Heinrich-Heine-University and University\n                    Hospital Duesseldorf, Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Schott","sequence":"additional","affiliation":[{"name":"Division for Specific Endocrinology, Heinrich-Heine-University and\n                    University Hospital Duesseldorf, Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik Lars","family":"Giesel","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Heinrich-Heine-University and\n                    University Hospital Duesseldorf, Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Roderburg","sequence":"additional","affiliation":[{"name":"Clinic for Gastroenterology, Hepatology and Infectious Diseases,\n                    Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven Heiko","family":"Loosen","sequence":"additional","affiliation":[{"name":"Clinic for Gastroenterology, Hepatology and Infectious Diseases,\n                    Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Luedde","sequence":"additional","affiliation":[{"name":"Clinic for Gastroenterology, Hepatology and Infectious Diseases,\n                    Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram Trudo","family":"Knoefel","sequence":"additional","affiliation":[{"name":"Department of Surgery (A), Heinrich-Heine-University and University\n                    Hospital Duesseldorf, Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2496-1079","authenticated-orcid":false,"given":"Andreas","family":"Krieg","sequence":"additional","affiliation":[{"name":"Department of Surgery (A), Heinrich-Heine-University and University\n                    Hospital Duesseldorf, Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,4,5]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1210\/jc.2005-2730","article-title":"Clinical and biological features in the prognosis of adrenocortical cancer: poor\n                    outcome of cortisol-secreting tumors in a series of 202 consecutive\n                    patients","volume":"91","author":"G Abiven","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1210\/jc.2006-0706","article-title":"Prognostic parameters of metastatic adrenocortical carcinoma","volume":"92","author":"G Assi\u00e9","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1210\/er.2013-1029","article-title":"Adrenocortical carcinoma","volume":"35","author":"T 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Abdel-Rahman","year":"2022","journal-title":"J Endocrinol Invest"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1093\/annonc\/mdv329","article-title":"Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European\n                    network for the study of adrenal tumor (ENSAT) study","volume":"26","author":"R Lib\u00e9","year":"2015","journal-title":"Ann Oncol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"3130","DOI":"10.1002\/cncr.23886","article-title":"Adrenocortical carcinoma in the United States: treatment utilization and\n                    prognostic factors","volume":"113","author":"K Y Bilimoria","year":"2008","journal-title":"Cancer"},{"key":"ref30","first-page":"885","article-title":"Deficits in the management of patients with adrenocortical carcinoma in\n                    Germany","volume":"107","author":"S Johanssen","year":"2010","journal-title":"Dtsch Arztebl Int"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1210\/jc.2014-3182","article-title":"Major prognostic role of Ki67 in localized adrenocortical carcinoma after\n                    complete resection","volume":"100","author":"F Beuschlein","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1507\/endocrj.K07-079","article-title":"Immunohistochemistry of a proliferation marker Ki67\/MIB1 in\n                    adrenocortical carcinomas: Ki67\/MIB1 labeling index is a predictor for\n                    recurrence of adrenocortical carcinomas","volume":"55","author":"R Morimoto","year":"2008","journal-title":"Endocr J"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1530\/EJE-18-0450","article-title":"Influence of hormonal functional status on survival in adrenocortical carcinoma:\n                    systematic review and meta-analysis","volume":"179","author":"T Vanbrabant","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1016\/j.surg.2014.08.018","article-title":"A novel staging system for adrenocortical carcinoma better predicts survival in\n                    patients with stage I\/II disease","volume":"156","author":"E A Asare","year":"2014","journal-title":"Surgery"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1200\/JCO.2002.20.4.941","article-title":"Adrenocortical carcinoma: clinical, morphologic, and molecular\n                    characterization","volume":"20","author":"A Stojadinovic","year":"2002","journal-title":"J Clin Oncol"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1007\/s00423-010-0698-y","article-title":"Proposal for modification of the ENSAT staging system for adrenocortical\n                    carcinoma using tumor grade","volume":"395","author":"B S Miller","year":"2010","journal-title":"Langenbecks Arch Surg"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s12020-019-02141-2","article-title":"The clinical utility of 'GRAS' parameters in stage I-III\n                    adrenocortical carcinomas: long-term data from a high-volume institution","volume":"67","author":"J Liang","year":"2020","journal-title":"Endocrine"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1530\/EJE-21-0510","article-title":"S-GRAS score for prognostic classification of adrenocortical carcinoma: an\n                    international, multicenter ENSAT study","volume":"186","author":"Y S Elhassan","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"R27","DOI":"10.1530\/EJE-22-0260","article-title":"Endocrine tumours: Our experience with the management of patients with\n                    non-metastatic adrenocortical carcinoma","volume":"187","author":"M Terzolo","year":"2022","journal-title":"Eur J Endocrinol"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"2372","DOI":"10.1056\/NEJMoa063360","article-title":"Adjuvant mitotane treatment for adrenocortical carcinoma","volume":"356","author":"M Terzolo","year":"2007","journal-title":"N Engl J Med"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"3730","DOI":"10.1210\/jc.2008-0579","article-title":"Adjuvant mitotane for adrenocortical cancer-a recurring controversy","volume":"93","author":"H Huang","year":"2008","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2042-2431.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T18:50:51Z","timestamp":1680720651000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2042-2431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,24]]},"references-count":37,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2023,4,5]]},"published-print":{"date-parts":[[2023,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2042-2431","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,2,24]]},"published":{"date-parts":[[2023,2,24]]}}}