New Risk Score Predicts Survival in Rare Adrenal Cancer Using Simple Blood Tests

Adrenocortical carcinoma (ACC) is a rare but highly aggressive cancer affecting the adrenal glands, with particularly poor outcomes in advanced stages. Despite treatment with mitotane chemotherapy alone or combined with other drugs, survival rates remain low, and doctors have lacked reliable tools to predict which patients might respond better to treatment.

Researchers from 11 international medical centers analyzed data from 418 patients with advanced ACC to identify factors that predict survival and treatment response. The study included patients receiving various treatment regimens including mitotane alone, combination chemotherapy, or second-line therapies.

The team discovered that four key factors independently predicted shorter survival: higher tumor burden, excess cortisol production, poor physical performance status, and elevated neutrophil-to-lymphocyte ratio (a simple blood test marker of inflammation). They combined these into the ENSAT Risk Score, with patients scoring above 2 points classified as high-risk.

High-risk patients showed dramatically worse outcomes across all treatment types, with 3-4 times higher risk of death and 2.5-3 times faster disease progression. The scoring system also predicted poor response to both first-line mitotane therapy and second-line treatments, making it valuable for treatment planning.

This research provides clinicians with a practical, evidence-based tool using readily available clinical information to guide treatment decisions and patient counseling. While this study focuses on a rare cancer, the approach of using inflammatory markers and performance status to predict outcomes may have broader applications in cancer care and longevity medicine, particularly regarding how systemic inflammation affects treatment response and survival.