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With recent progress in understanding the pathogenesis of adrenocortical tumors (ACTs), identification of molecular markers to predict their prognosis has become possible. Transcription factor 21 (TCF21)/podocyte-expressed 1 (POD1) is a transcriptional regulatory protein expressed in mesenchymal cells at sites of epithelial–mesenchymal transition during the development of different systems. Adult carcinomas express less  TCF21  than adenomas, in addition, the KEGG pathway analysis has shown that  BUB1B , among others genes, is negatively correlated with  TCF21  expression. The difference between  BUB1B  and PTEN-induced putative kinase 1 ( PINK1 ) expression has been described previously to be associated with survival in adult but not in pediatric carcinomas. Here, we analyzed the gene expression of  TCF21, BUB1B, PINK1 , and  NR5A1  in adult and pediatric ACTs. We found a negative correlation between the relative expression levels of  TCF21  and  BUB1B  in adult ACTs, but the relative expression levels of  TCF21, BUB1B, PINK1 , and  NR5A1  were similar in childhood ACTs. In addition, we propose using the subtracted expression levels of the  TCF21/POD-1  genes as a predictor of overall survival (OS) in adult carcinomas and  TCF21-NR5A1  as a predictor of malignancy for pediatric tumors in patients aged <5 years. These results require further validation in different cohorts of both adult and pediatric samples. Finally, we observed that the OS for patients aged <5 years was markedly favorable compared with that for patients >5 years as well as adult patients with carcinoma. In summary, we propose  TCF21/POD-1  as a new prognostic marker in adult and pediatric ACTs.

TCF21/POD-1, a Transcritional Regulator of SF-1/NR5A1, as a Potential Prognosis Marker in Adult and Pediatric Adrenocortical Tumors