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Nachresektions-Adrenokortikalkarzinom mit hohen Rezidiv-Risiko-Features — ENSAT-Stadium...

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IDRF-ACC-HIGH-RECURRENCE-RISK-BIOLOGY
ArtWarnhinweis
Statusreviewed 2026-07-11 | pending_clinical_signoff
ErkrankungenDIS-ADRENOCORTICAL-CARCINOMA
QuellenSRC-ADIUVO-TERZOLO-2023 SRC-ENSAT-ACC-2018 SRC-ESMO-ACC-2020

Ursprung der Roten Flagge

BegriffsbestimmungNachresektions-Adrenokortikalkarzinom mit hohen Rezidiv-Risiko-Features — ENSAT-Stufe III, Ki-67-Proliferationsindex >10% oder unvollständig/unsicher (R1/RX)-Resektionsmarge — definiert die Population, für die adjuvantes Mitotan empfohlen wird. In der randomisierten ADIUVO-Studie wurde kein signifikanter rezidivfreier Überlebensvorteil aus Adjuvantem Mitotane in der eingeschriebenen Gruppe mit geringem/mittlerem Risiko (ENSA-Stufe I-III, R0-Resektion, Ki 67 <=10%).
Klinische RichtungIntensivierung
Kategoriehigh-risk-biology
Schaltet AlgorithmusALGO-ACC-1L

Logik auslösen

{
  "any_of": [
    {
      "finding": "acc_ensat_stage",
      "value": "III"
    },
    {
      "comparator": ">",
      "finding": "ki67_proliferation_index_pct",
      "threshold": 10
    },
    {
      "finding": "resection_margin_status",
      "value": "R1"
    },
    {
      "finding": "resection_margin_status",
      "value": "RX"
    }
  ],
  "type": "composite_clinical"
}

Anmerkungen

ADIUVO (Terzolo 2023, Lancet Diabetes Endocrinol) defined its low/intermediate-risk enrollment population as ENSAT stage I-III, R0 resection, Ki-67 <=10%, and found no significant recurrence-free- survival benefit from adjuvant mitotane in that population (5-yr RFS 79% mitotane vs 75% surveillance, HR 0.74, not significant). By extension, this RedFlag fires on the features that place a resected patient OUTSIDE the ADIUVO low/intermediate-risk definition: stage III, Ki-67 >10%, or incomplete/uncertain resection margin (R1/RX). This is this KB's first-pass operationalization of "high recurrence risk" for adjuvant mitotane and is STUB / pending clinical co-lead confirmation against the primary ENSAT/ESMO guideline text — those guidelines may specify additional or more granular risk criteria (e.g. tumor rupture, vascular invasion, mitotic count / Weiss-Helsinki score components) not yet encoded here. The finding keys used (acc_ensat_stage, ki67_proliferation_index_pct, resection_margin_status) are newly introduced in this authoring pass and not yet wired to any intake questionnaire — a mechanical/data-availability gap, not a clinical-content gap.

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