Change of treatment modality and outcomes of adrenocortical carcinoma: a retrospective review of single tertiary center experience over 24 years

Background: Adrenocortical carcinoma, a rare malignancy, has a poor prognosis, and the treatment modalities have not been well established. This study aimed to analyze the trend of treatment modalities and outcomes of patients with adrenocortical carcinoma. Methods: We retrospectively analyzed 94 patients with adrenocortical carcinoma between January 1995 and June 2020 for distributions according to the American Joint Committee on Cancer (AJCC) 8th edition tumor-node-metastasis (TNM) staging, the yearly trend of demographic features, differences in multidisciplinary treatment, and prognostic outcomes. Multidisciplinary treatment included any combination of treatment including surgery, mitotane, chemotherapy or radiation. Results: The mean age and tumor size were 48.9 years and 11.7 cm, respectively. Fifteen patients (16.0%) underwent surgery only, and 56 (59.6%) underwent surgery with additional multidisciplinary treatments. Initial curative treatment was performed in all patients with stage 1 (n=5), 33 patients with stage 2 (n=34, 97.1%), 12 patients with stage 3 (n=19, 63.2%), and 11 patients with stage 4 (n=36, 30.6%) (P<0.0001). Two patients (40.0%) with stage 1 presented recurrence. In stages 2, 3, and 4, 57.6%, 58.3%, and 90.9% of patients who received curative treatment had recurrences, respectively. The annual trend presented statistical differences in mitotane use that have been increasing recently (P<0.0001). Conclusions: Overall distribution of adrenocortical carcinoma stage was similar throughout the years. Although the rate of mitotane use in the treatment of patients with Adrenocortical carcinoma has increased over time, recurrences were common even after multidisciplinary curative treatment in all stages. The treatment effect and prognostic outcomes presented no promising progression even with adjuvant chemotherapy and mitotane use in addition to surgical treatment. Adrenocortical carcinoma still presented an extremely poor prognosis, and further prospective studies are needed.