TP53 and neoplasm: Lippert et al. found an improved prognostic stratification when implementing a modified Grading (G; ENSAT and Ki67), resection status (R), Age (A) and as tumor- or hormone-related symptoms (S) (mGRAS) system, by recognizing four ACC subgroups with a different clinical outcome by merging mGRAS and a molecular score (number of somatic mutations, alterations in the Wnt/b-catenin and p53/Rb pathways and promoter region methylation pattern) into a combined (COMBI) score.