69 A recent study conducted by the Turkish Oncology Group sheds light on the challenges faced in treating adrenocortical carcinoma (ACC), a rare but highly malignant cancer. The research involved 157 patients, providing a comprehensive analysis of the clinical features, management strategies, and prognostic factors linked to survival. The findings were published in the journal Clinical Genitourinary Cancer. ACC remains a highly aggressive form of cancer, with many patients experiencing symptoms related to the tumour or the excessive production of hormones. These hormonal imbalances often lead to symptoms such as high blood pressure, weight gain, or skin changes. The study revealed that 89.4% of patients were symptomatic at diagnosis, while a smaller percentage, 10.6%, were diagnosed incidentally. ACC is often diagnosed at an advanced stage, further complicating treatment options. Surgical treatment, specifically adrenalectomy, is currently the most effective option for patients with localised ACC. In this study, the majority of patients, 79.6%, underwent surgery. However, 24.1% of those surgeries resulted in positive margins, meaning cancerous cells remained after the operation. This highlights the difficulties surgeons face when attempting to completely remove the tumour due to its size or location. Additionally, the recurrence rate of ACC remains a significant concern, with 79.1% of patients experiencing a relapse after surgery. While surgery remains a vital tool in treating ACC, its effectiveness is significantly reduced in patients with metastatic disease. Only those who underwent surgery had improved survival rates, a finding consistent with previous research. However, surgery alone is insufficient, and adjuvant therapies such as chemotherapy and radiotherapy are often used to prevent recurrence. The study identified several key factors influencing survival in patients with ACC. Among these, age, hormonal activity, and the proliferation marker Ki67 were highlighted as crucial indicators. Patients under the age of 65 had better overall survival rates compared to older patients. Additionally, those whose tumours were not actively producing hormones had a significantly better prognosis. The Ki67 marker, which measures how quickly tumour cells are dividing, was particularly important. Patients with a Ki67 value above 10 had much worse outcomes than those with a lower value. The study also found that patients with positive lymph node involvement had a significantly decreased overall survival rate. This highlights the importance of lymph node status in determining the progression of the disease. One of the most debated topics in ACC treatment is the role of adjuvant therapy, particularly mitotane, a drug used to suppress adrenal gland function. In this study, 44.4% of patients received adjuvant therapy, yet its effectiveness in prolonging survival remains inconclusive. Many patients experienced adverse effects, including fatigue and nausea, limiting the drug’s long-term use. Additionally, the overall contribution of chemotherapy to survival in patients with metastatic disease was not statistically significant. As the study concludes, ACC remains difficult-to-treat cancer with a generally poor prognosis. While surgical resection offers the best chance of survival, particularly in localised cases, more effective therapies are urgently needed for patients with advanced disease. The findings underscore the importance of early diagnosis and ongoing research into novel treatments to improve outcomes for those affected by this rare cancer.