Factors Affecting Survival in Adrenocortical Cancers: Single-Center Experience

Objective: Adrenocortical cancer (ACC) is one of the rare endocrine system cancers that are aggressive. Despite surgical treatment, the mortality rate is quite high. This study aimed to examine prognostic factors affecting survival in patients with ACC, the role of dehydroepiandrosterone sulfate (DHEA-S), and the maximum standard uptake (SUVmax) values on predicting mortality through the single-center data. Material and Methods: A total of 21 patients who were diagnosed with adrenal cancer and followed from a single center were included in the study. Patients who survived follow-ups were included in the survived group (n=6), and those who died were included in the dead group (n=15). The demographic, anatomical, pathological, and clinical characteristics of the patients were analyzed. Positron emission tomography-computerized tomography imaging and SUVmax values of adrenal masses were compared. The effect of all these data on survival was examined. Results: The mortality rate among patients with ACC was 71%. According to the Kaplan-Meier survival analysis, the average life expectancy was 23.66±2.79 (95% CI=18.18-29.13) months. The mass size of the survived and dead groups was 9.2±3.82 cm and 10.84±4.74 cm, respectively. The production rate of adrenal hormone was higher in the dead group (p<0.01; 80%). Moreover, the DHEA-S level and SUVmax values were statistically significantly higher in the dead group (p<0.001; p<0.05, respectively). Although no metastases were observed in the survived group during follow-ups after the operation, distant metastases were observed in 8 people from the dead group (53%; p<0.05). Conclusion: The mortality rate was very high in ACC despite surgical and medical treatments. The higher DHEA-S and SUVmax values may indicate that the overall survival duration was low.