Prognostic and monitoring value of circulating tumour cells in adrenocortical carcinoma: a preliminary monocentric study.

Adrenocortical carcinoma (ACC), a rare and aggressive neoplasia, presents poor prognosis when metastatic at diagnosis and limited therapies. Specific and sensitive markers for early diagnosis and a monitoring system of therapy and tumour evolution are urgently needed. The liquid biopsy represents a source of tumour material within a minimally-invasive blood draw that allows the recovery of circulating tumour cells (CTCs). CTCs have been recently shown to be detectable in ACC. In the present paper, we evaluated the prognostic value of CTCs obtained by size-filtration in a small pilot cohort of 19 ACC patients. We found CTCs in 68% of presurgery and in 38% of postsurgery blood samples. In addition, CTC clusters (CTMs) and cancer associated macrophages (CAMLs) were detectable in some ACC patients. CTC median number significantly decreased after the mass removal. Finally, stratifying patients in high and low presurgery CTC number groups, assuming the 75th percentile CTC value as cut-off, CTCs significantly predicted patients’ overall survival (log rank=0.005), also in a multivariate analysis adjusted for age and tumour stage. In conclusion, though preliminary and performed in a small cohort of patients, our study suggests that CTC number may represent a promising marker for prognosis and disease monitoring in ACC.