Clinical and pathological predictors of death for adrenocortical carcinoma

Eduardo Pato; Victor Srougi; Claudia Zerbini; Felipe Ledesma; Fabio Tanno; Madson Almeida; William Nahas; Latronico Ana Claudia; Berenice Mendonca; Jose Chambo; Fragoso Maria Candida

doi:10.1530/endoabs.99.EP183

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Endocrine Abstracts (2024) 99 EP183 | DOI: 10.1530/endoabs.99.EP183

ECE2024 Eposter Presentations Endocrine-Related Cancer (90 abstracts)

Clinical and pathological predictors of death for adrenocortical carcinoma

Eduardo Pato ¹ , Victor Srougi ¹ , Claudia Zerbini ² , Felipe Ledesma ³ , Fabio Tanno ¹ , Madson Almeida ⁴ , William Nahas ¹ , Ana Claudia Latronico ⁴ , Berenice Mendonca ⁴ , Jose Chambô ¹ & Maria Candida Fragoso ⁴

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¹Hospital das Clínicas, University of São Paulo School of Medicine, Division of Urology, São Paulo, Brazil; ²Hospital das Clínicas, University of São Paulo School of Medicine, Division of Pathology, São Paulo, Brazil; ³Hospital das Clínicas, University of São Paulo School of Medicine, Division of Pathology, São Paulo, Brazil; ⁴Hospital das Clínicas, University of São Paulo School of Medicine, Division of Endocrinology, São Paulo, Brazil

Adrenocortical Carcinoma (ACC) is a rare and lethal disease with a poor prognosis. This study aims to share our 41-year experience as a referral center, focusing on identifying risk factors associated with ACC mortality. Our retrospective analysis included a cohort of 150 adult patients with ACC in all stage categories, treated between 1981 and 2022. Tumor hormonal hypersecretion was observed in 78.6% of the patients, and the median age of diagnosis was 40 years. The majority presented as ENSAT III or IV (22.9% and 31.2%, respectively), and the overall mortality rate was 54.6%. Independent predictors of death were elevated secretion of cortisol (HR=2.0), androstenedione (HR=2.2), estradiol (HR=2.8), 17-OH progesterone (HR=2.0), and 11-deoxycortisol (HR=5.1), higher Weiss (HR=4.3), modified Weiss (HR=4.4), and Helsinki scores (HR=12.0), advanced ENSAT stage (HR=27.1), larger tumor size (HR=2.7), higher Ki-67% (HR=2.3), and incomplete surgical resection (HR=2.5). Mitosis >5/50HPF (HR=5.6), atypical mitosis (HR=2.3), confluent necrosis (HR=15.4), venous invasion (HR=2.8), and capsular invasion (HR=2.4), were also identified as independent predictors of death. Knowing the risk factors for ACC’s mortality may help determine the best treatment option.