{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:53:41Z","timestamp":1791384821457,"version":"4.3.3"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005010","name":"Italian Association for Cancer Research","doi-asserted-by":"publisher","award":["IG2019-23069"],"award-info":[{"award-number":["IG2019-23069"]}],"id":[{"id":"10.13039\/501100005010","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The impact of environmental pollution on adrenocortical carcinoma (ACC) remains largely unexplored. Although a few studies have assessed the incidence of ACC in polluted areas, no data are available on clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We carried out a retrospective multicentre cohort study in adult patients with ACC diagnosed in 12 referral centres in Italy (1990-2018). We stratified patients for (1) residence in sites officially classified as contaminated (NPCSs [National Priority Contaminated Sites]) or in non-contaminated areas and (2) urbanization, as a contextual proxy for environmental exposure. Outcomes were recurrence-free survival (RFS) and overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 336 patients, 250 had localized disease (stage I-III) and 86 metastatic disease (stage IV). Subgroups among patients with stage IV ACC were too small for a meaningful analysis. Among patients with localized ACC, 26 (10.4%) living in NPCSs had significantly shorter median RFS (13 vs 43 months; P = .011) and OS (67 vs 142 months; P = .016) compared to the 224 patients living in non-contaminated areas. At multivariable analysis, residence in NPCSs was independently associated with both recurrence (HR 1.89, 95% CI 1.13-3.16, P = .016) and death (HR 2.44, 95% CI 1.39-4.28, P = .002). No significant association was found between the level of urbanization and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides the first evidence that environmental pollution is associated with worse clinical outcomes in patients with ACC. By linking contaminated-area residence with prognosis, these findings raise the possibility that environmental exposures may contribute to the disease behaviour, highlighting a new direction for integrated epidemiological and biological research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvag184","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:15:51Z","timestamp":1790334951000},"page":"574-589","source":"Crossref","is-referenced-by-count":0,"title":["Environmental pollution is associated with poorer survival in patients with adrenocortical carcinoma: findings from a national cohort study in Italy"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2883-6139","authenticated-orcid":false,"given":"Soraya","family":"Puglisi","sequence":"first","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin , 10043 Orbassano ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin , 10043 Orbassano ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9981-3314","authenticated-orcid":false,"given":"Erika","family":"Messina","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin , 10043 Orbassano ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7472-6598","authenticated-orcid":false,"given":"Francesco","family":"Ferra\u00f9","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Department of Human Pathology DETEV, University of Messina , 98125 Messina ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ylenia","family":"Alessi","sequence":"additional","affiliation":[{"name":"Endocrine Unit of University Hospital G. 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