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Comparison between functional and non-functional adrenocortical carcinoma.

Alaa Sada1, Malke Asaad2, Katherine A Bews3

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Functional adrenocortical carcinomas are linked to worse survival, but complete surgical resection eliminates this difference. Further research is needed to optimize treatment strategies for these tumors.

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Area of Science:

  • Endocrinology
  • Oncology
  • Surgical Oncology

Background:

  • Adrenocortical carcinomas (ACC) are rare adrenal tumors.
  • Approximately 50% of ACCs are functional, producing excess hormones.
  • The impact of functional status on ACC outcomes is debated.

Purpose of the Study:

  • To compare the presentation and survival of functional versus nonfunctional ACCs.
  • To investigate the influence of tumor characteristics on patient outcomes.

Main Methods:

  • Retrospective analysis of 266 adult patients with ACC treated at Mayo Clinic.
  • Comparison of clinical presentation, tumor characteristics, and survival data between functional and nonfunctional ACCs.
  • Statistical analysis including survival curves and multivariate Cox regression.

Main Results:

  • 53% of ACCs were functional.
  • Functional ACCs were associated with younger age, female sex, and higher rates of metastatic disease at presentation.
  • Median overall survival was significantly shorter for functional ACCs (22 months) compared to nonfunctional ACCs (66 months).
  • Functional ACCs were independently associated with shorter survival (HR=1.5, P=0.03).

Conclusions:

  • Functional ACCs in this cohort had worse long-term survival.
  • However, when patients with complete surgical resection (R0) were analyzed, no significant survival difference was observed between functional and nonfunctional ACCs.
  • These findings highlight the need for a better understanding of ACC behavior to personalize treatment strategies.