EP905 - ECE_3681 - The picture of adrenocortical carcinoma recurrence upon mitotane in adjuvant setting in a cohort from Central Europe Center

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Abstract As adrenocortical carcinomais the malignancy known for its preponderance to relapse, adjuvate therapy is a crucial issue in patient management.The clinical justification for the use of adjuvant therapy is to reduce the risk of local and distant recurrenceand/or improve survival. Mitotane is the mainstay of adjuvant treatmentin adrenocortical carcinoma. The main objective of the study was to assess the characteristics oradrenocortical recurrence upon adjuvant mitotane treatment depending on known risk factors. We retrospectively reviewed medical recordsfrom the Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, atertiary center in Poland. We identified 88 patients treated with mitotane in the adjuvant setting between 2002 and 2024. The exclusion criteria wereENSAT stage IV andR2 resection. The date of recurrence was defined as the date ofradiological evidence of a new neoplastic lesion.Recurrence- free survivalwas calculated from thetime of initial surgeryto the first radiological evidence of recurrence. The risk of recurrence was assessed according to ENSAT stage, Ki67, and hormonal activity. Among the 88 patients, 22 (25%) patients were in the ENSAT IIIstage. Ki67 above 10% was confirmed in 39 patients (44%). In 17 patients (19%), resection was evaluated as R1.Recurrence was confirmed in 50% of patients receiving adjuvant mitotane treatment. However, in the subgroup of patients with Ki 67 between 10 and 20% recurrence rate was 66,7% and in Ki67 >20% reached70%. Regardingthe ENSAT stage,the relapse occurred in11,1% patients withENSAT I stage, 52,4% with the ENSAT II, and 45,4% in the ENSAT III stage.The median time to recurrence was 28 months (range 1-258).66% of recurrences occurred within 24 months. The median follow-up timewas 42 months (range 2-288). In both univariate and multivariate analyses, Ki67 andENSAT stage were factors significantly influencing the risk of recurrence. A significant effect of tumor hormonal activity on the risk of recurrence was confirmed only in univariate analysis. Reported data show a stillhigh recurrence rate in adrenocortical carcinomapatients with with Ki 67 >10% despite mitotaneadjuvant treatment.The results raisethe need for more individualized and maybe more aggressive adjuvant treatmentin adrenocortical carcinoma patients with high Ki67.

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