Adrenal cortical carcinoma--a continuing challenge

The records of 62 patients (36 female and 26 male) with pathologically confirmed adrenal cortical carcinoma who had operations between 1960 and 1980 were reviewed. The mean age was 48 years. There were 36 (58%) functioning tumors and 26 (42%) nonfunctioning tumors. Curative resection was performed in 31 patients, palliative resection in 14, and open biopsy alone in 17 with an overall operative mortality rate of 9.7% and a 5-year survival rate of 16%. There was no significant difference in survival rates between patients who had operations alone and those who had operations plus adjunctive therapy. Patients with stages I to III lesions or those who underwent curative resections had significantly longer survival than had those with stage IV disease or those who had palliative resections, respectively. Factors that failed to influence survival rates included palliative resection versus biopsy, tumor size, grade, function, and patient sex or age. We conclude that operative staging is prognostically valuable, aggressive surgical treatment is recommended in stages I to III lesions, and a prospective randomized study of adjuvant treatment for all stages of adrenal cortical carcinoma is indicated.