Endocrine Abstracts

Adrenocortical carcinoma (ACC) is a rare and very aggressive tumor with poor prognosis. The aim of the study was to identify prognostic factors of recurrence-free (RFS) and overall survival (OS) in patients with ACC.

We present a retrospective analysis in 52 patients diagnosed with ACC. A number of factors both histological and clinical were analyzed. Recurrent disease was defined as a new lesion confirmed in imaging. Kaplan-Meier method and multivariate Cox proportional hazard regression model was performed with adjustment for sex, age and ENSAT staging as covariates.

The study included 36 females and 16 males of median age 48 and 57 respectively. Forty six patients underwent surgical resection, six had unrespectable disease. Forty six patients received adjuvant mitotane. Twenty eight patients suffered from recurrent disease. Thirty four patients died due to disease progression. The 5-year overall survival for stage I, II, III and IV disease was 75, 66.5, 29.2 and 0%, respectively. The median of recurrence-free survival was 24.4 months (1.5–132.8) and 43 months (2.3–165.18) for overall survival. Age, male sex, stage, mitotic rate >20/50 high power fields, tumor necrosis, tumor invasion of vessels, neighbouring structure or adjacent organs and time from first imaging to surgery over 70 days were associated with decreased both RFS and OS. Unrespectable disease, macroscopically involved margins or tumor infiltration of capsule with crossing its border were only related to poor OS. Ki67, hormonal activity, tumor size, thrombus in vena cava had no influence on RFS or OS.

Our study indicates a major role of prognostic factors on survival in patients with ACC. The 5-year survival, median of RFS and OS were worse than previously reported. Due to the aggressive behavior of ACC and high percentage of relapse it is crucial to conduct more studies in order to help improving survival.