Recurrence of adrenal cortical carcinoma following resection: surgery alone can achieve results equal to surgery plus mitotane

Ann Surg Oncol. 2010 Jan;17(1):263-70. doi: 10.1245/s10434-009-0716-x. Epub 2009 Oct 23.


Background: A recent nonrandomized interinstitutional study reported that adjuvant mitotane following surgery for adrenocortical carcinoma (ACC) was associated with decreased recurrence. Because of the limitations of this study, we investigated the influences of surgery and adjuvant mitotane in a large series of ACC patients evaluated and treated at a single referral center.

Study design: Retrospective evaluation of patients followed at a single institution after surgery for ACC.

Results: 218 patients with ACC underwent primary resection either at the index institution [surgery index (SI), n = 28] or an outside institution [surgery outside (SO), n = 190] and had a median follow-up of 88 months. SI patients had a superior disease-free survival compared with SO patients (median 25 versus 12 months, P = 0.003), and SI patients also had a superior overall survival compared with SO patients (median not reached versus 44 months, P = 0.02). Factors predicting increased risk of recurrence on multivariate analysis were surgery at an outside institution [hazard ratio (HR) 2.56, 95% confidence interval (CI) 1.44-4.53, P = 0.001] and no treatment with adjuvant mitotane (HR 1.95, 95% CI 1.06-3.59, P = 0.03), and those predicting a poorer survival were advanced stage at presentation (P = 0.01) and surgery at an outside institution (HR 2.62, 95% CI 1.31-5.25, P = 0.007).

Conclusions: The recurrence rate of the index group (50%) in the current series, the overwhelming majority of whom did not receive adjuvant mitotane, is indistinguishable from that reported for those who received adjuvant mitotane (49%) in the recent interinstitutional report, emphasizing the importance of completeness of initial surgery in the management of patients with ACC.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adolescent
  • Adrenal Cortex Neoplasms / drug therapy
  • Adrenal Cortex Neoplasms / surgery*
  • Adrenocortical Carcinoma / drug therapy
  • Adrenocortical Carcinoma / surgery*
  • Adult
  • Aged
  • Antineoplastic Agents, Hormonal / therapeutic use*
  • Chemotherapy, Adjuvant
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mitotane / therapeutic use*
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Staging
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome
  • Young Adult


  • Antineoplastic Agents, Hormonal
  • Mitotane