Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection

Objective: To identify the pathologic features of prognostic significance in patients with resectable adrenocortical carcinomas. Design: Retrospective review. Setting: Tertiary referral center. Patients: Review of the Memorial Sloan-Kettering Cancer Center prospective adrenocortical carcinoma database from 1986 through 1996 identified 46 patients who underwent curative adrenalectomy for primary disease. All cases were reviewed by a single pathologist and each primary tumor was characterized by 16 separate pathologic parameters. Main Outcome Measure: Overall survival rates in the patient population. Results: The 5-year overall survival rate for the entire cohort was 36% (median survival rate, 28 months). Of the pathologic factors analyzed, tumor size, number of mitotic figures, and the presence of intratumoral hemorrhage were independent prognostic factors. Patients presenting with primary tumors larger than 12 cm (n=30) had a worse outcome compared with those with smaller tumors (n=16) (5-year survival rate: 53% vs 22%, P<.05). Mitotic count (greater than or equal to 6 per 10 high-power fields) was a negative prognostic feature (n=15) with a 5-year survival rate of 13% vs 51% for 0 to 6 mitotic figures per 10 high-power fields (n=31, P<.05). Intratumoral hemorrhage (n=23) was also a negative prognostic factor compared with no evidence of intratumoral hemorrhage (n=23) (5-year survival rate, 53% vs 22%, P<.05). Overall survival rates were also calculated based on the number of pathologic risk factors. Patients with no risk factors had an 83% 5-year survival rate, which decreased to 42% with 1 factor, 33% with 2 factors, and 0% with all 3 risk factors. Conclusions: Tumor size, hemorrhage, and mitotic count correlate with survival rates for patients undergoing curative resection. Based on these pathologic factors, adrenocortical carcinomas may be divided into low- and highrisk groups.