Ann Surg Treat Res.  2024 Oct;107(4):187-194. 10.4174/astr.2024.107.4.187.

Early stage adrenocortical carcinoma—what contributes to poor prognosis after adrenalectomy? A retrospective cohort study

• Kwon D
• Rah CS
• Kim BC
• Pak SJ
• Cho JW
• Kim WW
• Lee Ym
• Lee JL
• Song DE
• Chung KW
• Sung TY

• KMID: 2560003
• DOI: http://doi.org/10.4174/astr.2024.107.4.187

Abstract

Purpose
Adrenocortical carcinoma (ACC) is a rare primary carcinoma originating in the adrenal gland with a poor prognosis and a high recurrence rate. This study evaluated the risk factors associated with recurrence in patients with early stage ACC after curative surgical resection.
Methods
The present study retrospectively evaluated the risk factors for recurrence in 38 patients with stages 1 and 2 ACC who underwent curative resection between 1995 and 2020.
Results
Recurrence was observed in 21 patients (55.3%), with no significant difference between stages 1 and 2 ACC (P = 0.640). The overall recurrence rate was higher in patients who underwent minimally invasive surgery than open adrenalectomy (71.4% vs. 51.6%). Of the 33 patients with gross tumor margins negative for malignancy, 16 (48.5%) experienced tumor recurrence, and all 5 patients with positive and unknown gross resection margins had recurrence. Recurrences were observed in 14 of the 30 patients (46.7%) negative for pathologic resection margins, 6 of the 7 patients (85.7%) with pathologically indeterminate margins, and 1 patient with pathologically positive margins.
Conclusion
The recurrence rates are high even in patients with early stage ACC, being higher in patients who undergo minimally invasive surgery than open adrenalectomy. Obtaining clear resection margins during surgery may reduce tumor recurrence; however, gross or pathologic margin safety was not a secure factor in preventing recurrence. None of the factors analyzed was a definitive predictor of poor prognosis.

Keyword

Adrenocortical carcinoma; Adrenalectomy; Early stage; Recurrence