gms | German Medical Science

Introduction: Adrenal cortical carcinomas (ACC) are rare endocrine neoplasms with poor prognosis. ACCs are usually in an advanced stage when diagnosed. This is usually due to the unspecific symptoms. Complete surgical resection remains the only potentially curative treatment for the affected patients. In this retrospective study we investigated the surgical outcome, disease free survival and overall survival of ACC patients treated at a single tertiary care hospital.

Material and methods: Retrospective analysis of 50 patients with ACC who underwent a primary resection from 1986 to 2013 in the surgery Department of the Heinrich Heine University and University Hospital Düsseldorf. Data on patient demographics, clinical symptoms, diagnostic course and disease stage, clinical and histological outcome were considered. Follow up data were collected to evaluate disease free survival and overall survival. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) 22.0 for Windows.

Results: 50 patients, median age of 48.5 (SD 15.5, range 14-89) underwent an adrenalectomy. The median age for female patients was 46.5 and for male patients 52.5 years. The maximal occurrence is at the age 40-60 years. Recurrence free survival after complete resection (R0) was in median 14,5 months (n=16, SD 34.4). Duration of the operation and hospital stay were significantly shorter in younger patients (< 46 year of age) and in patients with small tumors (UICC/WHO stages I and II versus III and IV). Metastases free survival was in median 31 months (n=15, SD 44.2). In univariate analysis gender, tumor size, tumor localisation and postoperative complication rate were prognostic factors. Overall survival was 9 months in median (n=32, SD 33.7). Gender, tumor size and age were not of prognostic value. However the tumor stage especially the existence of metastases at the time of diagnosis was a prognostic factor.

Conclusion: Our data suggest that male patients have a disadvantage in the recurrence-free survival but have an advantage in the metastasis-free survival as well as the overall survival. Adjuvant mitotane may prolong median survival but the results are still disappointing and it has no significant prognostic value. To avoid an imbalance in standardized treatment of patients with ACC these patients should be treated by an experienced multidisciplinary team in specialized endocrine centres. However untill now an indiviualised treatment concept must be fit for each patient depending on tumor stage, patient's condition and age.

Figure 1 [Fig. 1]