The aim of the study was analysis of long-term results of surgical treatment in patients with adrenocortical carcinoma as well as definition of prognostic factors.
From 1998 to 2008, examination and treatment of 53 patients with adrenocortical carcinoma (31 women and 22 men, mean age 52.8 years) was carried out in our institute: 13 patients had Cushing syndrome, 1 virilization, 2 total adrenohypercortisolism, and 37 nonfunctioning tumors. The mean tumor diameter was 8.7 cm (range, 321), weight 301.2 g (range, 212000). Four patients were at stage I, 8 at stage II, 25 at stage III, and 16 at stage IV; 48 patients were operated on, and in five cases, surgical intervention was abandoned because of the multiple distant metastases (the diagnosis was confirmed by cytologic analysis of the fine-needle aspiration biopsy tumor samples). Radical surgery with complete resection of the primary tumor was performed in 42 patients. Among them, four patients underwent combined resection en bloc with adjacent organs (kidney, spleen and pancreas), three patients liver segmentectomy, and one lung resection. Incomplete tumor resection was performed in two patients. In four other patients, only tumor biopsy was performed. Patients not treated surgically died 37 months later diagnosis. Patients, who underwent incomplete tumor resection or only tumor biopsy, died 524 months later surgery. The mean follow-up after radical surgical treatment was 48.2 months (range, 286): 28 patients are still alive and 14 died. The 5-year overall and disease-free survival, calculated by the KaplanMeier method, was 58.3 and 55.1%, respectively. There were no reliable differences among overall and disease-free survival rates and tumor functional activity depending on patient age and sex. The 5-year overall and disease-free survival rate for patients at stage I and II was 100%, for patients at stage III 51.9 and 47.4%, for patients at stage IV 0%. The 5-year overall and disease-free survival for patients with tumors less than 10 cm (60.6 and 59.2%) was significantly higher than those for patients with tumors more than 10 cm (0%).
Complete resection of primary tumor (with adjacent organs and, when feasible, solitary metastases) and pathological tumor stage are the most significant prognostic factors in patients with adrenocortical carcinoma.
25 - 29 Apr 2009
European Society of Endocrinology