{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:09:06Z","timestamp":1791482946272,"version":"4.3.4"},"reference-count":41,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Grupo Espa\u00f1ol Medicina Traslacional y Tumores Hu\u00e9rfanos e Infrecuentes"},{"DOI":"10.13039\/501100016389","name":"Sociedad Espa\u00f1ola de Endocrinolog\u00eda y Nutrici\u00f3n","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016389","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018813","name":"Esteve-HRA Pharm Rare Disease","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018813","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy with a high risk of postoperative recurrence. Although adjuvant mitotane is commonly used, its potential for achieving cure rather than simply postponing inevitable recurrence remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study investigates whether mitotane impacts ACC recurrence patterns by preventing or delaying recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective analysis used data from the ICARO-GETTHI\/SEEN registry, which includes 36 Spanish hospitals. Recurrence in nonmetastatic ACC patients after resection was analyzed using Cox models, flexible longitudinal models, and mixture cure models to evaluate the impact of mitotane.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 244 patients, 133 (52%) received adjuvant mitotane, with therapeutic levels monitored in 84%. Findings suggest a possible \u201ccure fraction\u201d with a 32.5% estimated 30-year cure rate (95% CI, 23.4%-45.0%). Cox regression indicated a 39% reduced recurrence risk (HR 0.61; 95% CI, 0.39-0.95) for mitotane-treated patients, with effects diminishing over 24 months. Mixture cure models suggest mitotane primarily delays rather than prevents recurrence. Effect modification analysis showed significant benefit in male patients (HR 0.33; 95% CI, 0.16-0.69), younger patients, tumors with higher Ki-67% (modeled as a continuous variable), and those with venous invasion (HR 0.47; 95% CI, 0.27-0.82), with potential synergy when combined with radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study underscores the intriguing possibility that adjuvant mitotane delays recurrence, yet questions remain as to its curative capacity. The early benefit suggests a cytostatic effect, but certain subgroups\u2014especially males, younger individuals, and those with high-risk tumors\u2014may experience a more durable outcome. Further research is needed to explore mitotane's curative potential in ACC management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf082","type":"journal-article","created":{"date-parts":[[2025,2,9]],"date-time":"2025-02-09T15:13:24Z","timestamp":1739114004000},"page":"3155-3167","source":"Crossref","is-referenced-by-count":6,"title":["Does Adjuvant Mitotane Impact Cure Rates in Adrenocortical Carcinoma? Insights From the ICARO-GETTHI\/SEEN Registry"],"prefix":"10.1210","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1930-9660","authenticated-orcid":false,"given":"Alberto","family":"Carmona-Bayonas","sequence":"first","affiliation":[{"name":"Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigaci\u00f3n Biosanitaria (IMIB), Universidad de Murcia (UMU) , 30008 Murcia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4448-7941","authenticated-orcid":false,"given":"Cristina","family":"\u00c1lvarez-Escol\u00e1","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department, Hospital Universitario La Paz , 28046 Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada","family":"Ballester Navarro","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Hospital 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