Adrenocortical carcinoma: Is prognosis different in nonfunctioning tumors?Results of surgical treatment in 31 patients

From 1980 to 1998 a series of 265 patients with adrenal tumors underwent su rgery, with an adrenocortical carcinoma found in 31 (11.7%). Altogether, 17 (54.8%) patients (group A) had Cushing syndrome (n = 15) or virilization ( n = 2), and 14 (45.2%) patients (group B) had nonfunctioning adrenal tumors . Tumor staging was as follows: (groups A/B): stage I, n = 5 (3/2), stage I I, n = 14 (9/5), stage III, it = 5 (1/4), stage TV, n = 7 (4/3) patients. T here were 12 (38.7%) men and 19 (61.3%) women (median age 51 years, range 2 5-73 years), and the size of the mass ranged from 3.5 to 20.0 cm (median 8. 0 cm), with no differences (p = NS) between groups A and B. Two (6.4%) pati ents (stage TV) did not undergo surgery and received only palliative drug t reatment; 6 (19.4%) were treated with debulking surgery: 15 (48.4%) had uni lateral adrenalectomy; and 8 (25,8%) had an extended adrenalectomy. Eightee n (58.0%) patients underwent adjuvant postoperative mitotane treatment, and in 8 (25.8%) patients one or more reoperations for recurrence were require d. Nine (29.0%) patients are still alive with a mean Follow-up of 34 months ; 22 (71.0%) died 2 to 60 months (median 20 months) after surgery. The over all 2- and 5-year survival rates were 62.1% and 10.3%, with no difference ( p = NS) between groups A and B, The survival rates at the 1-and 3-year foll ow-ups were 90.3% and 32.3% (stages I and II) and 71.0% and 6.5% (stages II I and IV). In conclusion, adrenocortical carcinoma remains a highly maligna nt tumor, and stage III-IV patients still have a poor prognosis; but nonfun ctioning tumors do nut seem to be more aggressive.