Validation of the prognostic role of the "Helsinki Score” in 225 cases of adrenocortical carcinoma

Abstract

Adrenocortical carcinoma patient prognosis is extremely variable and poorly predictable. The newly introduced Helsinki Score is the first so far proposed diagnostic and prognostic system based on the combined evaluation of morphological (mitoses and necrosis) and immunohistochemical (Ki-67) parameters. The aim of the study was to validate the prognostic role of the Helsinki Score for adrenocortical carcinoma characterization. Thus, 225 adrenocortical carcinomas were reclassified using the Weiss Score and the Helsinki Score (3× mitotic count + 5 × necrosis + Ki-67 index). At univariate analysis, statistically significant prognostic values were observed at the log-rank test for mitotic count (cutoff values: <6 and ≥55; P<.0001), Ki-67 (cutoff values: <20 and ≥50; P<.0001), Weiss Score (cutoff values: <5 and ≥8; P<.0001), Helsinki Score (cutoff values: <13 and ≥19; P<.0001), histological variant (conventional versus oncocytic; P=.009), necrosis (P=.001), and stage (P=.005). Cox multivariate analysis using a backward stepwise selection method retained only Helsinki Score and Weiss Score as predictors of poor prognosis (P<.0001 and P=.0005, respectively). Helsinki Score (with a threshold of 28.5 points; area under the curve [AUC]=0.729, 95% confidence interval=0.66-0.79) and Ki-67 (with a threshold of 20.5%; AUC=0.727, 95% confidence interval=0.66-0.79) showed the best and equivalent AUCs predicting disease-related deaths determined using receiver operating characteristic statistics. In conclusion, the Helsinki Score is a valuable system to predict prognosis in adrenocortical carcinoma, outperforming the currently established prognostic parameters.

The Utrecht Score: A novel histopathological scoring system to assess the prognosis of dogs with cortisol‐secreting adrenocortical tumours

“…In humans, the prognosis of patients with an ACC does not only differ from that of patients with an ACA, but the prognosis also varies greatly within the group of patients with an ACC . In human ACCs, histopathological criteria that are associated with a poor prognosis include high mitotic rate, high Ki67 proliferation index (PI), and high Helsinki score …”

“…The differentiation between an adrenocortical adenoma (ACA) and adrenocortical carcinoma (ACC) is usually based on histopathology. Although several studies have been conducted on the histopathological analysis of human ACTs, [2][3][4][5][6][7][8][9] the literature on canine ACTs is less extensive. The most recent study on histopathology of canine ACTs was published in 2004, in which the authors compared a number of histopathological criteria between ACAs and ACCs.…”

“…3,[11][12][13][14] In humans, the prognosis of patients with an ACC does not only differ from that of patients with an ACA, but the prognosis also varies greatly within the group of patients with an ACC. 8,15 In human ACCs, histopathological criteria that are associated with a poor prognosis include high mitotic rate, high Ki67 proliferation index (PI), and high Helsinki score. 7,8,16,17 The objective of this retrospective study was to establish a reliable and easy-to-use histopathological scoring system for cortisolsecreting ACTs that can assess the prognosis of dogs after adrenalectomy.…”

The next step: mechanisms driving adrenocortical carcinoma metastasis

“…This system was shown to be able to predict the metastatic potential of ACC with very high sensitivity and specificity (Pennanen et al 2015). Another very recent study extended and confirmed the prognostic validity of the Helsinki score on a larger series of ACC cases (Duregon et al 2017).…”

“…A recent large multicentric ENS@T study has shown that the KI67 LI is a very reliable parameter to predict disease recurrence (disease-free survival, DFS) and overall survival (OS) in ACC patients after complete tumor resection . Furthermore, Ki67 LI integration with morphological parameters in the newly introduced Helsinki score makes it to outperform the Weiss system as a prognostic indicator in ACC (see above) (Pennanen et al 2015, Duregon et al 2017. However, a limitation of the Ki67 LI consists in difficulties in its standardization and reproducibility when applied to many tumor types, including ACC (Papathomas et al 2016).…”