Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection

Objective: To identify the pathologic features of prognostic significance i n patients with resectable adrenocortical carcinomas. Design: Retrospective review. Setting: Tertiary referral center. Patients: Review of the Memorial Sloan-Kettering Cancer Center prospective adrenocortical carcinoma database from 1986 through 1996 identified 46 pati ents who underwent curative adrenalectomy for primary disease. All cases we re reviewed by a single pathologist and each primary tumor was characterize d by 16 separate pathologic parameters. Main Outcome Measure: Overall survival rates in the patient population. Results: The 5-year overall survival rate for the entire cohort was 36% (me dian survival rate, 28 months). Of the pathologic factors analyzed, tumor s ize, number of mitotic figures, and the presence of intratumoral hemorrhage were independent prognostic factors. Patients presenting with primary tumo rs larger than 12 cm (n=30) had a worse outcome compared with those with sm aller tumors (n=16) (5-year survival rate: 53% vs 22%, P<.05). Mitotic coun t (greater than or equal to 6 per 10 high-power fields) was a negative prog nostic feature (n=15) with a 5-year survival rate of 13% vs 51% for 0 to 6 mitotic figures per 10 high-power fields (n=31, P<.05). Intratumoral hemorr hage (n=23) was also a negative prognostic factor compared with no evidence of intratumoral hemorrhage (n=23) (5-year survival rate, 53% vs 22%, P<.05 ). Overall survival rates were also calculated based on the number of patho logic risk factors. Patients with no risk factors had an 83% 5-year surviva l rate, which decreased to 42% with 1 factor, 33% with 2 factors, and 0% wi th all 3 risk factors. Conclusions: Tumor size, hemorrhage, and mitotic count correlate with survi val rates for patients undergoing curative resection. Based on these pathol ogic factors, adrenocortical carcinomas may be divided into low- and highri sk groups.