Endocrine Abstracts

Background: The aim of the study was to evaluate urine steroid profiles by gas chromatography–mass spectrometry (GC–MS) in patients with adrenocortical carcinoma (ACC) to assess therapy efficacy.

Patients and Methods: 39 ACC patients were examined before and after treatment. The median age was 47 years (41–60). The Weiss score was no less than 4 points. 10 patients were disease-free in the early postoperative period (up to 12 months after surgery). Metastases were detected 1–5 years after the surgery in 29 patients. The control group consisted of 25 patients with adrenocortical adenoma (ACA) without malignant features defined by the histologic analysis. The median age was 52 (47–61) years. We studied urine steroid profile using gas chromatograph–mass spectrometer SHIMADZU GCMS – TQ 8050. Statistical data was processed with software STATISTICA for WINDOWS (Version 10). Results comparison was made using Mann–Whitney test.

Results: ACC’s main biomarkers urinary excretion rates [dehydroepiandrosterone (DHEA), etiocholanolone (Et), pregnanediol (P2), pregnanetriol (P3), pregnenediol (dP2), pregnenetriol (dP3)] did not differ between the disease-free postoperative ACC patients and the control group (P>0.05). The 3β,16,20-dP3 urinary excretion rate and the 3α16,20-dP3/3β,16,20-dP3 ratio were identified as the most discriminating markers in differentiating disease-free postoperative patients from preoperative ACC patients (receiver-operating characteristics (ROC) analysis revealed sensitivity=100%, specificity=96%, AUC =0.99, cut-off <194 μg/24 h and sensitivity=85.7%, specificity=92%, AUC=0.87, cut-off >3.4, respectively). Patients after surgery and chemotherapy had decreased urinary excretion rates of 3β,16,20-dP3 (cut-off < 100 μg/24 h sensitivity=specificity=100%, AUC =1,0) and the increase of 3α16,20-dP3/3β,16,20-dP3 ratio (cut-off > 2.7 sensitivity=75%, specificity=88%, AUC=0.81) in comparison with the same patients’ preoperative steroid profiles. Patients with recurrent ACC (in the postoperative period before the chemotherapy initiation or with the relapse occurrence after the completion of chemotherapy) had the similar excretion rates of ACC biomarkers as in the preoperative period.

Conclusion: Urine steroid profiling is a promising tool for the evaluation of treatment efficacy in ACC patients.