title: Risk of adrenocortical carcinoma in adrenal tumours greater than 8 cm.
abstract: BACKGROUND
  Adrenocortical cancer (ACC) is a rare malignancy. In the absence of metastatic disease, the suspicion of ACC is based on size and radiological appearance. The aim of this study was to analyse the long-term outcome of patients with large adrenal cortical tumours (>8 cm).
  
  
  METHODS
  A prospective database recorded clinical, biochemical, operative and histological data on patients operated for cortical adrenal tumours between January 2000 and February 2013. Out of 130 patients operated for cortical adrenal tumours, analysis was restricted to 37 cortical tumours >8 cm.
  
  
  RESULTS
  There were 31 (84 %) ACCs and 6 (16 %) benign adenomas (p < 0.01). The most common presentation was that of an abdominal mass [17 (55 %) vs. 3 (50 %), ACC vs. benign, respectively]. There was no difference in size between stage II and stage III-IV tumours; however, there was a trend for tumours to be heavier in advanced stages (920 ± 756 vs. 1,435 ± 1,022 g, p = 0.08, stage II vs. stage III-IV, respectively). No mortality was observed in patients with benign tumours during a median follow-up of 70 months (range 36-99 months). Mortality in the ACC group occurred in 17/31 (55 %) patients. Mitotane was administered in 12 (71 %) patients with stage III-IV ACCs with a 5-year survival rate 25 % compared to 20 % in patients who did not receive Mitotane. In stage II ACC, eight (57 %) patients received Mitotane with a 50 % mortality at 5 years.
  
  
  CONCLUSIONS
  The high incidence of ACC in cortical tumours >8 cm underlines the need for adequate surgical resection via open surgery aiming to avoid local recurrence. Beyond surgery, the impact of other therapies is not fully characterised and the efficacy of adjuvant Mitotane treatment is yet to be proven.
authors.affiliation: Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Trust, Old Road, Headington, Oxford, OX3 7LE, UK, t.abdel-aziz@ucl.ac.uk.
authors.forename: Tarek Ezzat
authors.initials: TE
authors.lastname: Abdel-Aziz
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Rajeev
authors.forename: Greg
authors.initials: G
authors.lastname: Sadler
authors.forename: Andrew
authors.initials: A
authors.lastname: Weaver
authors.forename: Radu
authors.initials: R
authors.lastname: Mihai
mesh_terms: D000236:Adenoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008939:Mitotane / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D008939:Mitotane