OBJECTIVE To evaluate the performance characteristics of AJCC 7th and 8th staging systems among patients with adrenal cortical carcinoma. METHODS Surveillance, Epidemiology, and End Results (SEER) 18-registry was accessed and patients with adrenocortical carcinoma who were diagnosed 2010-2015 with complete information about AJCC 7th staging system were included. AJCC 8th staging system information was then reconstructed for each patient using available TNM staging variables. Kaplan-Meier overall survival estimates, multivariable Cox regression analysis, and concordance index (C-statistic) were used to examine the performance characteristics of both staging systems. RESULTS A total of 574 patients with a diagnosis of adrenocortical carcinoma were included in the current analysis. Using Kaplan-Meier survival estimates, overall survival was compared among different AJCC stages for both versions; and the P value was significant (< 0.001) for both comparisons. C-statistic was then calculated for both staging systems and the results were as follows: for AJCC 7th version: 0.726 (95% CI 0.683-0.769); and for AJCC 8th version: 0.745 (95% CI 0.704-0.786). Patients with M1 disease (stage IV according to AJCC 8th edition) were then divided according to the extent of distant metastases into single versus multiple sites of metastases. Using Kaplan-Meier survival estimates, patients with a single site of metastases have better overall survival (P = 0.006). A C-statistic for a hypothetical modification of AJCC 8th staging system subdividing stage IV patients into IVA and IVB based on the number of metastatic sites was: 0.753 (95% CI 0.713-0.794). CONCLUSIONS There is a minimal difference in the prognostic performance between both versions of the AJCC staging system. Subdivision of stage IV cancer into stage IVA and IVB (according to the number of organs with metastatic deposits) should be considered in subsequent versions of adrenocortical carcinoma staging.

中文翻译：

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重新审视肾上腺皮质癌的 AJCC 分期系统。

目的评价 AJCC 第 7 和第 8 分期系统在肾上腺皮质癌患者中的表现特征。方法 访问监测、流行病学和最终结果 (SEER) 18 登记处，纳入 2010-2015 年被诊断为具有 AJCC 第 7 分期系统完整信息的肾上腺皮质癌患者。然后使用可用的 TNM 分期变量为每位患者重建 AJCC 第 8 分期系统信息。Kaplan-Meier 总生存期估计、多变量 Cox 回归分析和一致性指数（C 统计量）用于检查两种分期系统的性能特征。结果 共有 574 名诊断为肾上腺皮质癌的患者被纳入本次分析。使用 Kaplan-Meier 生存估计，比较两种版本的不同 AJCC 阶段的总生存期；两种比较的 P 值均显着（< 0.001）。然后计算两个分期系统的 C 统计量，结果如下：对于 AJCC 第 7 版：0.726（95% CI 0.683-0.769）；对于 AJCC 第 8 版：0.745 (95% CI 0.704-0.786)。然后根据远处转移的程度将 M1 病患者（根据 AJCC 第 8 版的 IV 期）分为单个或多个转移部位。使用 Kaplan-Meier 生存估计，具有单个转移部位的患者具有更好的总体生存率 (P = 0.006)。AJCC 第 8 分期系统根据转移部位的数量将 IV 期患者细分为 IVA 和 IVB 的假设修改的 C 统计量为：0.753（95% CI 0.713-0.794）。结论 AJCC 分期系统的两个版本之间的预后性能差异很小。在后续版本的肾上腺皮质癌分期中应考虑将 IV 期癌症细分为 IVA 期和 IVB 期（根据转移性沉积的器官数量）。