Recommandations conjointes du réseau National ENDOCAN-COMETE, de l’Association francophone de chirurgie endocrinienne et de la Société française d’urologie pour la prise en charge du carcinome corticosurrénalien
Bibliographic record
Abstract
Le carcinome corticosurrénalien est une tumeur maligne primitive développée aux dépens de la corticosurrénale, définie par un score de Weiss ≥ 3. Son pronostic est sombre et dépend surtout du stade au diagnostic. Sa prise en charge est assurée en France par les centres experts pluridisciplinaires du réseau national ENDOCAN-COMETE « Cancers de la Surrénale », labellisé par l’Institut national du cancer. Ce document met à jour les recommandations sur la prise en charge du carcinome corticosurrénalien de l’adulte basées sur les données les plus robustes et récentes de la littérature. Il est divisé en onze chapitres : (1) les circonstances de découvertes ; (2) le bilan pré-thérapeutique ; (3) le diagnostic du carcinome corticosurrénalien ; (4) l’oncogénétique ; (5) les classifications pronostiques ; (6) le traitement de l’hypersécrétion hormonale ; (7) le traitement des formes localisées ; (8) le traitement des rechutes ; (9) le traitement des formes avancées ; (10) le suivi ; (11) le cas particulier du carcinome corticosurrénalien et de la grossesse. Des organigrammes sur le traitement des carcinomes corticosurrénaliens localisés, les rechutes et les carcinomes corticosurrénaliens avancés sont proposés. Un enjeu majeur est la réalisation de la chirurgie dans un centre expert et l’obtention d’une résection R0 des carcinomes corticosurrénaliens localisés. Ce document est rédigé par les experts du réseau national ENDOCAN-COMETE et validé par les experts de l’ensemble des sociétés savantes françaises impliquées dans la prise en charge de ces patients (endocrinologie, oncologie médicale, chirurgie endocrinienne, urologie, pathologie, génétique, médecine nucléaire, radiologie, radiologie interventionnelle). The adrenocortical carcinoma (ACC) is a primary malignant tumor developed from the adrenal cortex, defined by a Weiss score ≥ 3. Its prognosis is poor and depends mainly on the stage of the disease at diagnosis. Care is organized in France by the multidisciplinary expert centers of the national ENDOCAN-COMETE “Adrenal Cancers” network, certified by the National Cancer Institute. This document updates the guidelines for the management of ACC in adults based on the most robust data in the literature. It's divided into 11 chapters: (1) circumstances of discovery; (2) pre-therapeutic assessment; (3) diagnosis of ACC; (4) oncogenetics; (5) prognostic classifications; (6) treatment of hormonal hypersecretion; (7) treatment of localized forms; (8) treatment of relapses; (9) treatment of advanced forms; (10) follow-up; (11) the particular case of ACC and pregnancy. R0 resection of all localized ACC remains an unmet need and it must be performed in expert centers. Flow-charts for the therapeutic management of localized ACC, relapse or advanced ACC are provided. It was written by the experts from the national ENDOCAN-COMETE network and validated by all French Societies involved in the management of these patients (endocrinology, medical oncology, endocrine surgery, urology, pathology, genetics, nuclear medicine, radiology, interventional radiology).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.035 | 0.086 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.005 | 0.006 |
| Insufficient payload (model declined to judge) | 0.010 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".