The long-term survival in adrenocortical carcinoma with active surgical management and use of monitored mitotane.
Journal article, 2010

Adrenocortical carcinoma (ACC) is a rare tumour disease with sinister prognosis also after attempts to radical surgery; better prognosis is seen for low-stage tumours. Adjuvant treatment with the adrenolytic drug mitotane has been attempted, but not proven to prevent from recurrence. The drug may offer survival advantage in case of recurrence. The aim of this single-centre study (1979-2007) of 43 consecutive patients was to evaluate the long-term survival after active surgical treatment combined with monitored mitotane (to reduce side effects of the drug). The series is unique, since all patients were offered a period of mitotane as adjuvant or palliative treatment; six patients refused mitotane. Despite a high proportion of high-stage tumours (67%), the complete resection rate was high (77%). The disease-specific 5-year survival was high (64.1%); very high for patients with low-stage tumours without evident relation to mitotane levels. Patients with high-stage tumours had a clear survival advantage with mitotane levels above a threshold of 14 mg/l in serum. The hazard ratio for patients with high mitotane levels versus all patients indicates a significant effect of the drug. The results indicate that adjuvant mitotane may be the standard of care for patients with high-stage ACC after complete resection.


Bo Wängberg

University of Gothenburg

Amir Khorram-Manesh

University of Gothenburg

Svante Jansson

University of Gothenburg

Bengt E Nilsson

University of Gothenburg

Ola Nilsson

University of Gothenburg

C E Jakobsson

University of Gothenburg

Sven Lindstedt

University of Gothenburg

Anders Odén

Chalmers, Mathematical Sciences, Mathematical Statistics

University of Gothenburg

Håkan Ahlman

University of Gothenburg

Endocrine-related cancer

1479-6821 (eISSN)

Vol. 17 1 265-72

Subject Categories






More information