title: Survival and prognostic factors for adrenocortical carcinoma: a single institution experience.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) is aggressive, but rare tumours that have not been sufficiently studied. The aim of our study was to present the demographic and clinical characteristics of patients with ACC, to determine the overall survival rates, analyse the effect of prognostic factors on survival, as well as to identify favorable and unfavourable predictors of survival.
  
  
  METHODS
  The study included 72 patients (42 women and 30 men) with ACC. We analysed the prognostic value of the demographic and clinical characteristics of the patients, tumour characteristics, therapy administered and survival rates. Kaplan-Meier survival curves and the log-rank test were used to estimate the overall and specific survival probabilities and the Cox regression model was used to identify independent prognostic factors for survival.
  
  
  RESULTS
  The patients had mean age of 50 years. The 1-, 5-, and 10-year probabilities of survival in patients with ACC were 52.5 %, 41.1 %, and 16.4 %, respectively. The median survival time was 36 months. The results of multivariate Cox regression analysis showed that the presence of lymphatic metastases (HR = 7.37, 95 % CI = 2.31-23.48, p = 0.001) and therapy with mitotane (HR = 0.11, 95 % CI = 0.04-0.27, p = 0.001) were independent prognostic factors for survival.
  
  
  CONCLUSIONS
  The presence of lymphatic metastasis is an unfavourable prognostic factor, while postoperative therapy with mitotane is a favorable prognostic factor for survival in patients with ACC.
authors.affiliation: Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia. loncarz2014@gmail.com.
authors.forename: Zlatibor
authors.initials: Z
authors.lastname: Loncar
authors.affiliation: Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia. vladimir.djukic@mfub.bg.ac.rs.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Djukic
authors.affiliation: Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia. vladanzivaljevic@gmail.com.
authors.forename: Vladan
authors.initials: V
authors.lastname: Zivaljevic
authors.affiliation: Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000, Serbia. pekmezovic@sezampro.rs.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Pekmezovic
authors.affiliation: Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia. adiklic@eunet.rs.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Diklic
authors.affiliation: Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000, Belgrade, Serbia. svetislav.tatic@mfub.bg.ac.rs.
authors.forename: Svetislav
authors.initials: S
authors.lastname: Tatic
authors.affiliation: Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000, Belgrade, Serbia. drdundjerovic@gmail.com.
authors.forename: Dusko
authors.initials: D
authors.lastname: Dundjerovic
authors.affiliation: Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia. bolujic@gmail.com.
authors.forename: Branislav
authors.initials: B
authors.lastname: Olujic
authors.affiliation: Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia. dr.nikola.slijepcevic@gmail.com.
authors.forename: Nikola
authors.initials: N
authors.lastname: Slijepcevic
authors.affiliation: Centre for Endocrine Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia. kipaun@eunet.rs.
authors.forename: Ivan
authors.initials: I
authors.lastname: Paunovic
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods; D018268:Adrenocortical Carcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D055815:Young Adult