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371 in advanced disease are still low, more recent stud‐ ies suggest that prognosis in early stages is im‐ proving.3,5 The European Network for the Study of Adrenal Tumors (ENSAT) staging system has a better prognostic stratification than the Inter‐ national Union Against Cancer classification; thus, it is widely used in contemporary studies.8 Stage I is defined as a tumor size of 5 cm or low‐ er; stage II, as a tumor size of more than 5 cm; stage III, any tumor size plus one of the follow‐ ing: tumor infiltration into surrounding organs, such as the kidney, pancreas, spleen, and liver or large blood vessels (renal vein or vena cava); and, finally, stage IV is defined as distant metastases.8 INTROduCTION Adrenocortical carcinoma (ACC) is a malignant tumor, associated with poor prog‐ nosis. Although this type of cancer is generally rare (0.5–2 cases/million/year),1 it was the most common finding after surgery (25.2%) in a series of 139 cases of adrenal tumors greater than 5 cm in size.2 The 5 ‐year survival rates in this aggres‐ sive cancer range between 16% and 44%,3 while the median overall survival (OS) varies from 32 to 77 months.1,4-7 Due to poor long ‐term outcome in patients with ACC, numerous retrospective studies have been conducted to identify prognostic factors. Prognosis of ACC is dependent on the tumor stage at presentation. Although the survival rates ORIGINAL ARTICLE

Prognostic factors in adrenocortical carcinoma: data from a large Polish series