title: Prognostic Factors for Adrenocortical Carcinoma Outcomes.
abstract: OBJECTIVE
  Adrenocortical carcinoma (ACC) is an aggressive tumor characterized by a high recurrence rate and poor response to treatment. This study analyzes a consecutive series of ACC patients to evaluate the prognostic value of various clinical and pathological characteristics.
  
  
  METHODS
  We retrospectively evaluated 32 ACC patients followed at our Medical Center from 1997 to 2015 and evaluated the prognostic value of age at diagnosis, gender, tumor functional status, stage, and type of treatment with respect to overall survival (OS) and disease-free survival (DFS), as determined by Kaplan-Meier curves.
  
  
  RESULTS
  ACC was associated with hormonal overproduction in 50% of cases, and patients with isolated hyperandrogenism had a better prognosis. Recurrence was observed in 12/26 (46.2%) patients with no evidence of disease after surgery. Tumor size [hazard ratio (HR) 1.32, 95% confidential intervals (CI) 1.12-1.64; p = 0.007], ki-67 (HR 1.06, 95% CI 1.02-1.11; p = 0.009) and advanced stage at diagnosis (III-IV) (HR 6.51, 95% CI 1.65-24.68; p = 0.006) were associated with recurrence in the 26 R0 patients in the univariate analysis. Advanced stage was an independent risk factor for recurrence in the multivariate analysis (HR 8.10, 95% CI 1.55-41.35; p = 0.01). Five-year survival was 40.0%. Positive resection margins (HR 10.61, 95% CI 3.02-38.31; p = < 0.001), ki-67 (HR 1.04, 95% CI 1.01-1.07; p = 0.01) and advanced stage (HR 11.31, 95% CI 1.45-87.76; p = 0.02) were associated with poor survival in all 32 patients, but only positive resection margins were an independent predictor of mortality in the multivariate analysis (HR 6.22, 95% CI 1.44-26.05; p = 0.01).
  
  
  CONCLUSIONS
  ACC has a poor prognosis with a high recurrence rate. Tumor stage at diagnosis and the completeness of surgical excision are the most relevant prognostic factors.
authors: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy.
authors: Claudia
authors: C
authors: Scollo
authors: Endocrinology, Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy.
authors: Marco
authors: M
authors: Russo
authors: Surgical Oncology, Garibaldi-Nesima Hospital , Catania , Italy.
authors: Maria Antonietta
authors: MA
authors: Trovato
authors: Medical Oncology, Garibaldi-Nesima Hospital , Catania , Italy.
authors: Daniela
authors: D
authors: Sambataro
authors: Istituto Oncologico del Mediterraneo, Viagrande , Catania , Italy.
authors: Dario
authors: D
authors: Giuffrida
authors: Pathology, Garibaldi-Nesima Hospital , Catania , Italy.
authors: Mario
authors: M
authors: Manusia
authors: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy.
authors: Giulia
authors: G
authors: Sapuppo
authors: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy.
authors: Pasqualino
authors: P
authors: Malandrino
authors: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Humanitas, Catania Oncology Center, Catania, Italy; Institute of Biostructures and Bioimaging, CNR, Catania, Italy.
authors: Riccardo
authors: R
authors: Vigneri
authors: Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy.
authors: Gabriella
authors: G
authors: Pellegriti
keywords: adrenal cancer; adrenocortical carcinoma; prognostic factors; recurrence; survival