Outcome of multidisciplinary management of adrenocortical carcinoma: a retrospective study

Abstract Background: Adrenocortical Carcinoma (ACC) is a rare and highly malignant tumor with a high recurrence rate. Reoperation to attain negative resection margin is recommended for selected patients. However, there is limited data on the outcome of unresectable recurrent tumor treated with palliative radiotherapy (RT) and transhepatic arterial embolization (TAE).Method: A retrospective analysis of the Peking Union Medical College Hospital was conducted. Patients with pathologically confirmed ACC were included.Result: Ninety-two patients fulfilled the criteria. The 5-year, 3-year, 1-year overall survival (OS) rates were 27.2%, 44.6% and 71.7% respectively, and median OS was 32.1 months. Age < 50 years, ENSAT stage I/II, surgery and negative surgical margin were associated with improved OS (all P <0.05). A Ki67 index < 20% was a predictor of better disease-free interval (P =0.011). Of 51 patients with recurrent ACC, local treatment (reoperation, palliative RT and TAE) improved OS after recurrence from 14.5 months to 41.6 months. Local therapy and mitotane were both prognostic factors for improved OS after recurrence.Conclusion: multidisciplinary treatment is the major therapeutic approach for ACC. Resectable cases should receive complete resection to attain negative margin. Local treatment such as palliative RT and TAE may extend OS for unresectable recurrence.