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Adrenocortical cancer: mortality, hormone secretion, proliferation and urine steroids ? experience from a single centre spanning three decades #MMPMID26984275
Calissendorff J; Calissendorff F; Falhammar H
BMC Endocr Disord 2016[]; 16 (ä): ä PMID26984275show ga
Background: Adrenocortical carcinoma (ACC) is a rare malignant disease with a poor prognosis. Our aims were to study survival and to explore prognostic markers. Methods: We retrospectively investigated the medical records of all 50 ACC patients at a single centre diagnosed between 1985 and 2012 and followed them up until 31/12/2014. Results: Of this cohort, twenty six (52 %) were females. Adrenalectomy was performed in 48 patients (96 %), and twenty seven (54 %) were treated with adjuvant cytotoxic agents. The tumor sizes ranged from 6 to 20 cm. Overall survival time was 5.5 years (0.3?19.8), the two and five-year survival was 64 and 40 %, respectively. In ENSAT stage II 25/48 patients had a median survival of 7.0 years (0.7?15.5), in stage III 8/48 this was 1.9 (0.4 ? 19.8), and in stage IV 15/48 it was 1.2 (0.3?3.6) years. Seventeen patients (34 %) were still alive at the end of 2014. The total follow-up time was 8.4 (0.3?19.8) years. Cell proliferation measured with Ki-67 had a median value of 15 % (2?80) and the urinary steroid profile was clearly pathologic in 29 of 43 (67 %) tested patients. The proliferation index did not significantly predict mortality (Ki-67???10 vs. >10 %, 9.0 vs. 3.2 years, P?=?0.0833), but resection margins did (R1 vs. R2, P?=?0.0066; R0 vs. R2, P?0.0001). The urinary steroid profile did not predict mortality (normal vs. pathologic urine profile: median survival 6.6 vs. 3.3 years, P?=?0.261). Conclusions: The prognosis was generally poor and macroscopically positive resection margins resulted in a worse prognosis. However, some patients were still alive many years following primary surgery with no sign of residual disease.