{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:55:31Z","timestamp":1793498131965,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Adrenocortical carcinoma (ACC) has an aggressive but variable clinical course. Prognostic stratification based on the European Network for the Study of Adrenal Tumours stage and Ki67 index is limited. We aimed to demonstrate the prognostic role of a points-based score (S-GRAS) in a large cohort of patients with ACC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This is a multicentre, retrospective study on ACC patients who underwent adrenalectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The S-GRAS score was calculated as a sum of the following points: tumour stage (1\u20132\u2009=\u20090; 3\u2009=\u20091; 4\u2009=\u20092), grade (Ki67 index 0\u20139%\u2009=\u20090; 10\u201319%\u2009=\u20091; \u226520%\u2009=\u20092 points), resection status (R0\u2009=\u20090; RX\u2009=\u20091; R1\u2009=\u20092; R2\u2009=\u20093), age (&lt;50 years\u2009=\u20090; \u226550 years\u2009=\u20091), symptoms (no\u2009=\u20090; yes\u2009=\u20091), and categorised, generating four groups (0\u20131, 2\u20133, 4\u20135, and 6\u20139). Endpoints were progression-free survival (PFS) and disease-specific survival (DSS). The discriminative performance of S-GRAS and its components was tested by Harrell\u2019s Concordance index (C-index) and Royston\u2013Sauerbrei\u2019s R\n                      <jats:sup>2<\/jats:sup>\n                      <jats:sub>D<\/jats:sub>\n                      statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 942 ACC patients. The S-GRAS score showed superior prognostic performance for both PFS and DSS, with best discrimination obtained using the individual scores (0\u20139) (C-index\u2009=\u20090.73, R\n                      <jats:sup>2<\/jats:sup>\n                      <jats:sub>D<\/jats:sub>\n                      = 0.30, and C-index\u2009=\u20090.79, R\n                      <jats:sup>2<\/jats:sup>\n                      <jats:sub>D<\/jats:sub>\n                      = 0.45, respectively, all\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.01vs each component). The superiority of S-GRAS score remained when comparing patients treated or not with adjuvant mitotane (\n                      <jats:italic>n<\/jats:italic>\n                      = 481 vs 314). In particular, the risk of recurrence was significantly reduced as a result of adjuvant mitotane only in patients with S-GRAS 4\u20135.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prognostic performance of S-GRAS is superior to tumour stage and Ki67 in operated ACC patients, independently from adjuvant mitotane. S-GRAS score provides a new important guide for personalised management of ACC (i.e. radiological surveillance and adjuvant treatment).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/eje-21-0510","type":"journal-article","created":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T11:19:19Z","timestamp":1635419959000},"page":"25-36","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-7","source":"Crossref","is-referenced-by-count":97,"title":["S-GRAS score for prognostic classification of adrenocortical carcinoma: an international, multicenter ENSAT study"],"prefix":"10.1093","volume":"186","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2735-6053","authenticated-orcid":true,"given":"Y S","family":"Elhassan","sequence":"first","affiliation":[{"name":"1Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK"},{"name":"2Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Altieri","sequence":"additional","affiliation":[{"name":"3Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Berhane","sequence":"additional","affiliation":[{"name":"4NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK"},{"name":"5Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Cosentini","sequence":"additional","affiliation":[{"name":"6Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Calabrese","sequence":"additional","affiliation":[{"name":"7Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Haissaguerre","sequence":"additional","affiliation":[{"name":"8Service d\u2019Endocrinologie \u2013 Diab\u00e8te et Nutrition CHU de Bordeaux, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Kastelan","sequence":"additional","affiliation":[{"name":"9Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M C B V","family":"Fragoso","sequence":"additional","affiliation":[{"name":"10Unidade de Suprarrenal da Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina do Hospital das Clinicas da Universidade de S\u00e3o Paulo (HCFMUSP), and Instituto do Cancer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Bertherat","sequence":"additional","affiliation":[{"name":"11Reference Center for Rare Adrenal Cancer (COMETE), Cochin Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Al Ghuzlan","sequence":"additional","affiliation":[{"name":"12Department of Pathology, Gustave Roussy Cancer Center, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Haak","sequence":"additional","affiliation":[{"name":"13Department of Internal Medicine, M\u00e1xima MC, Eindhoven, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Boudina","sequence":"additional","affiliation":[{"name":"14Department of Endocrinology, Theagenio Cancer Hospital, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4995-8108","authenticated-orcid":true,"given":"L","family":"Canu","sequence":"additional","affiliation":[{"name":"15Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Loli","sequence":"additional","affiliation":[{"name":"16Clinica Polispecialistica San Carlo, Paderno Dugnano, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Sherlock","sequence":"additional","affiliation":[{"name":"17Department of Endocrinology, Beaumont Hospital, and the Royal College of Surgeons, Dublin, Republic of Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Kimpel","sequence":"additional","affiliation":[{"name":"3Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Lagan\u00e0","sequence":"additional","affiliation":[{"name":"6Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7727-4497","authenticated-orcid":true,"given":"A J","family":"Sitch","sequence":"additional","affiliation":[{"name":"4NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK"},{"name":"5Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7628-3161","authenticated-orcid":true,"given":"M","family":"Kroiss","sequence":"additional","affiliation":[{"name":"3Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"},{"name":"18Comprehensive Cancer Center Mainfranken, University of W\u00fcrzburg, W\u00fcrzburg, Germany"},{"name":"19Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5106-9719","authenticated-orcid":true,"given":"W","family":"Arlt","sequence":"additional","affiliation":[{"name":"1Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK"},{"name":"2Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"},{"name":"4NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Terzolo","sequence":"additional","affiliation":[{"name":"7Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Berruti","sequence":"additional","affiliation":[{"name":"6Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J J","family":"Deeks","sequence":"additional","affiliation":[{"name":"4NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK"},{"name":"5Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Lib\u00e9","sequence":"additional","affiliation":[{"name":"20Department of Endocrinology and Metabolic Diseases, H\u00f4pital Cochin, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6170-6398","authenticated-orcid":true,"given":"M","family":"Fassnacht","sequence":"additional","affiliation":[{"name":"3Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"},{"name":"18Comprehensive Cancer Center Mainfranken, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5020-2071","authenticated-orcid":true,"given":"C L","family":"Ronchi","sequence":"additional","affiliation":[{"name":"1Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK"},{"name":"2Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"},{"name":"3Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","container-title":["European Journal of Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/186\/1\/EJE-21-0510.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eje.bioscientifica.com\/downloadpdf\/journals\/eje\/186\/1\/EJE-21-0510.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T11:16:48Z","timestamp":1676373408000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/186\/1\/25\/6853001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,1]]},"references-count":0,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.1530\/eje-21-0510","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,1]]}}}