Endocrinol Metab.  2024 Oct;39(5):803-812. 10.3803/EnM.2024.2086.

The Modified S-GRAS Scoring System for Prognosis in Korean with Adrenocortical Carcinoma

• Baek SK
• Lee SH
• Park SS
• Ahn CH
• Kong SH
• Kim WW
• Lee YM
• Kim SJ
• Song DE
• Sung TY
• Lee KE
• Kim JH
• Jung KC
• Koh JM

• KMID: 2560288
• DOI: http://doi.org/10.3803/EnM.2024.2086

Abstract

Background
Adrenocortical carcinomas (ACCs) are rare tumors with aggressive but varied prognosis. Stage, Grade, Resection status, Age, Symptoms (S-GRAS) score, based on clinical and pathological factors, was found to best stratify the prognosis of European ACC patients. This study assessed the prognostic performance of modified S-GRAS (mS-GRAS) scores including modified grade (mG) by integrating mitotic counts into the Ki67 index (original grade), in Korean ACC patients.
Methods
Patients who underwent surgery for ACC between January 1996 and December 2022 at three medical centers in Korea were retrospectively analyzed. mS-GRAS scores were calculated based on tumor stage, mG (Ki67 index or mitotic counts), resection status, age, and symptoms. Patients were divided into four groups (0–1, 2–3, 4–5, and 6–9 points) based on total mS-GRAS score. The associations of each variable and mS-GRAS score with recurrence and survival were evaluated using Cox regression analysis, Harrell’s concordance index (C-index), and the Kaplan–Meier method.
Results
Data on mS-GRAS components were available for 114 of the 153 patients who underwent surgery for ACC. These 114 patients had recurrence and death rates of 61.4% and 48.2%, respectively. mS-GRAS score was a significantly better predictor of recurrence (C-index=0.829) and death (C-index=0.747) than each component (P<0.05), except for resection status. mS-GRAS scores correlated with shorter progression-free survival (P=8.34E-24) and overall survival (P=2.72E-13).
Conclusion
mS-GRAS scores showed better prognostic performance than tumor stage and grade in Asian patients who underwent surgery for ACC.

Keyword

Adrenocortical carcinoma; Prognosis; Survival analysis; Recurrence

Figure

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  Fig. 1. Kaplan–Meier analyses of (A) progression-free survival and (B) overall survival according to modified Stage, Grade, Resection status, Age, Symptom (mS-GRAS) score grouping in patients with adrenocortical carcinoma who underwent adrenalectomy (n=114). Components of the mS-GRAS score included European Network for the Study of Adrenal Tumour (ENSAT) stage (S), modified grading (modified G), resection status (R), age (A), and tumor- or hormone-related symptoms (S).

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