A Computed Tomography-Based Score to Predict Survival in Patients With Adrenocortical Carcinoma: A Proof-of-Concept Study.

Adrenocortical carcinoma (ACC) is a rare condition with a poor and hardly predictable prognosis. This study aims to build and evaluate a preoperative computed tomography (CT)-based score (CT score) using features previously reported as biomarkers in ACC to predict overall survival (OS) in patients with ACC. A CT score based on preoperative CT examinations combining shape elongation, maximum tumour diameter, and the European Network for the Study of Adrenal Tumors (ENSAT) stage was built using a logistic regression model to predict OS duration in a development cohort of 89 patients with ACC. An optimal cut-off of the CT score was defined and the Kaplan-Meier method was used to assess OS. The CT score was then tested in an external validation cohort of 54 patients wit ACC. The C-index of the CT score for predicting OS was compared to that of ENSAT stage alone. The CT score helped discriminate between patients with poor prognosis and patients with good prognosis in both the validation cohort (54 patients; mean OS, 69.4 months; 95% confidence interval [CI]: 57.4-81.4 months vs mean OS, 75.6 months; 95% CI: 62.9-88.4 months, respectively; = .022). In the validation cohort the C-index of the CT score was significantly better than that of the ENSAT stage alone (0.62 vs 0.35; = .002). A CT score combining morphological criteria, radiomics, and ENSAT stage on preoperative CT examinations allows a better prognostic stratification of patients with ACC compared to ENSAT stage alone.