Abstract 56P
Background
Adrenocortical carcinoma (ACC) is a rare tumour arising from adrenal cortex. ACCs diagnosed as incidentalomas remain poorly characterized in terms of relative prevalence and outcome.
Methods
We conducted a retrospective analysis of adults (≥ 18 years) with a histologically confirmed ACC followed up at two referral centers in Russian Federation from 2021 to 2024. We studied urine steroid metabolomes in preoperative period using gas chromatograph-mass spectrometer SHIMADZU GCMS – QP2020.
Results
A total of 110 patients (67% women) were included in the study. Most patients had ACC stage II — 44.5%, ACC III — 26.4%, ACC IV — 22.7% and ACC I stage — 6.4%. The median follow-up was 12 (IQR, 7 to 36) months. Disease progression was diagnosed in 49.0%, death occurred in 22.7% patients. In our study 41.8 % of tumours were detected incidentally, 28.2% — during the examination for manifestation of Cushing`s syndrome, 30.0% of patients present with nonspecific symptoms due to local tumour growth. ACCs presenting as adrenal incidentalomas were diagnosed at earlier stages, with a smaller size compared with symptomatic tumours. All but one of the ACC stage I patients were diagnosed serendipitously. Patients with incidentally found ACC showed prolonged overall and recurrence-free survival in comparison with symptomatic ACC patients. At multivariate analysis ACC incidental detection was not associated with increased survival because of its link to favorable prognostic factor– earlier ACC stages. Patients with incidentally discovered tumours had decreased urinary excretion rates of important ACC biomarkers in comparison with patients with symptomatic adrenocarcinomas: androgens and their metabolites (dehydroepiandrosterone, androstentriol, 16-oxo-androstenediol), progesterone metabolites (3α,16α,20α-pregnenetriol, 3β,17α,20α-pregnenetriol, pregnenediol, pregnanediol, pregnanetriol, 17-OH-pregnanolone).
Conclusions
A large number of patients with incidentally discovered ACC underscores the importance of adrenal neoplasm assessment in the preoperative period, including GC-MS, for an early diagnosis with the intention to offer prompt surgery to patients with adrenocarcinomas.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.