Adrenocortical Carcinoma

Pyroptosis, apoptosis, and necroptosis are mainly programmed cell death (PCD) pathways for host defense and homeostasis. PANoptosis is a newly distinct inflammatory PCD pathway that is uniquely regulated by multifaceted PANoptosome complexes and highlights significant crosstalk and coordination among pyroptosis (P), apoptosis (A), and/or necroptosis(N). Although some studies have focused on the possible role of PANpoptosis in diseases, the pathogenesis of PANoptosis is complex and underestimated. Furthermore, the progress of PANoptosis and related agonists or inhibitors in disorders has not yet been thoroughly discussed. In this perspective, we provide perspectives on PANoptosome and PANoptosis in the context of diverse pathological conditions and human diseases. The treatment targeting on PANoptosis is also summarized. In conclusion, PANoptosis is involved in plenty of disorders including but not limited to microbial infections, cancers, acute lung injury/acute respiratory distress syndrome (ALI/ARDS), ischemia-reperfusion, and organic failure. PANoptosis seems to be a double-edged sword in diverse conditions, as PANoptosis induces a negative impact on treatment and prognosis in disorders like COVID-19 and ALI/ARDS, while PANoptosis provides host protection from HSV1 or Francisella novicida infection, and kills cancer cells and suppresses tumor growth in colorectal cancer, adrenocortical carcinoma, and other cancers. Compounds and endogenous molecules focused on PANoptosis are promising therapeutic strategies, which can act on PANoptosomes-associated members to regulate PANoptosis. More researches on PANoptosis are needed to better understand the pathology of human conditions and develop better treatment.

BackgroundAdjuvant treatment with mitotane is commonly used after resection of adrenocortical carcinoma; however, treatment remains controversial, particularly if risk of recurrence is not high. We aimed to assess the efficacy and safety of adjuvant mitotane compared with surveillance alone following complete tumour resection in patients with adrenocortical carcinoma considered to be at low to intermediate risk of recurrence.MethodsADIUVO was a multicentre, open-label, parallel, randomised, phase 3 trial done in 23 centres across seven countries. Patients aged 18 years or older with adrenocortical carcinoma and low to intermediate risk of recurrence (R0, stage I-III, and Ki67 ≤10%) were randomly assigned to adjuvant oral mitotane two or three times daily (the dose was adjusted by the local investigator with the target of reaching and maintaining plasma mitotane concentrations of 14-20 mg/L) for 2 years or surveillance alone. All consecutive patients at 14 study centres fulfilling the eligibility criteria of the ADIUVO trial who refused randomisation and agreed on data collection via the European Network for the Study of Adrenal Tumors adrenocortical carcinoma registry were included prospectively in the ADIUVO Observational study. The primary endpoint was recurrence-free survival, defined as the time from randomisation to the first radiological evidence of recurrence or death from any cause (whichever occurred first), assessed in all randomly assigned patients by intention to treat. Overall survival, defined as time from the date of randomisation to the date of death from any cause, was a secondary endpoint analysed by intention to treat in all randomly assigned patients. Safety was assessed in all patients who adhered to the assigned regimen, which was defined by taking at least one tablet of mitotane in the mitotane group and no mitotane at all in the surveillance group. The ADIUVO trial is registered with ClinicalTrials.gov, NCT00777244, and is now complete.FindingsBetween Oct 23, 2008, and Dec 27, 2018, 45 patients were randomly assigned to mitotane and 46 to surveillance alone. Because the study was discontinued prematurely, 5-year recurrence-free and overall survival are reported instead of recurrence-free and overall survival as defined in the protocol. 5-year recurrence-free survival was 79% (95% CI 67-94) in the mitotane group and 75% (63-90) in the surveillance group (hazard ratio 0·74 [95% CI 0·30-1·85]). Two people in the mitotane group and five people in the surveillance group died, and 5-year overall survival was not significantly different (95% [95% CI 89-100] in the mitotane group and 86% [74-100] in the surveillance group). All 42 patients who received mitotane had adverse events, and eight (19%) discontinued treatment. There were no grade 4 adverse events or treatment-related deaths.InterpretationAdjuvant mitotane might not be indicated in patients with low-grade, localised adrenocortical carcinoma considering the relatively good prognosis of these patients, and no significant improvement in recurrence-free survival and treatment-associated toxicity in the mitotane group. However, the study was discontinued prematurely due to slow recruitment and cannot rule out an efficacy of treatment.FundingAIFA, ENSAT Cancer Health F2-2010-259735 programme, Deutsche Forschungsgemeinschaft, Cancer Research UK, and the French Ministry of Health.

BackgroundTo identify prognostic genes which were associated with adrenocortical carcinoma (ACC) tumor microenvironment (TME).Methods and materialsTranscriptome profiles and clinical data of ACC samples were collected from The Cancer Genome Atlas (TCGA) database. We use ESTIMATE (estimation of stromal and Immune cells in malignant tumor tissues using expression data) algorithm to calculate immune scores, stromal scores and estimate scores. Heatmap and volcano plots were applied for differential analysis. Venn plots were used for intersect genes selection. We used protein-protein interaction (PPI) networks and functional analysis to explore underlying pathways. After performing stepwise regression method and multivariate Cox analysis, we finally screened hub genes associated with ACC TME. We calculated risk scores (RS) for ACC cases based on multivariate Cox results and evaluated the prognostic value of RS shown by receiver operating characteristic curve (ROC). We investigated the association between hub genes with immune infiltrates supported by algorithm from online TIMER database.ResultsGene expression profiles and clinical data were downloaded from TCGA. Lower immune scores were observed in disease with distant metastasis (DM) and locoregional recurrence (LR) than other cases (P = .0204). Kaplan-Meier analysis revealed that lower immune scores were significantly associated with poor overall survival (OS) (P = .0495). We screened 1649 differentially expressed genes (DEGs) and 1521 DEGs based on immune scores and stromal scores, respectively. Venn plots helped us find 1122 intersect genes. After analysing by cytoHubba from Cytoscape software, 18 hub genes were found. We calculated RS and ROC showed significantly predictive accuracy (area under curve (AUC) = 0.887). ACC patients with higher RS had worse survival outcomes (P ConclusionWe screened a list of TME-related genes which predict poor survival outcomes in ACC patients from TCGA database.

The 5th edition of the WHO classification of endocrine and neuroendocrine tumors represents a significant advancement in the diagnostic approach to adrenocortical carcinoma (ACC), integrating novel molecular insights with established histopathological criteria to enhance diagnostic accuracy and to refine prognostic assessment. This review outlines key histopathological features and diagnostic strategies for ACC, offering a practical framework for evaluation and grading in daily practice. The updated WHO classification reaffirms the central role of histopathology, employing multiparametric scoring systems that assess invasion, architectural and cytological features, mitotic activity, and necrosis. However, these parameters often pose interpretive challenges, and no single algorithm ensures complete sensitivity, specificity, or reproducibility. Therefore, combining diagnostic approaches is advisable, particularly in morphologically ambiguous cases. For tumor grading, the WHO employs a two-tiered system based on a mitotic count cut of 20 per 10 mm2, aiming to improve interinstitutional consistency. Immunohistochemistry remains essential for diagnostic confirmation and prognostic evaluation. Among available markers, SF1 is the most specific for adrenocortical origin, while Ki-67, mismatch repair proteins, p53, and β-catenin are useful for predicting patient outcomes or screening for hereditary predisposition. In this complex diagnostic setting, artificial intelligence holds potential to support ACC diagnostics. However, its application is limited by the rarity of the disease, histological variability, and the scarcity of large, well-annotated datasets necessary for algorithm development.