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OBJECTIVE To analysize the treatment and prognosis of primary adrenalcortical adenocarcinoma.METHODS Clinical data from 21 cases of patients with primary adrenocortical adenocarcinoma were reviewed. There were 14 males and 7 females, ranging in age from 2 to 67 years (mean 45.6). The tumors were unilateral, and on the right side in 16 and on the left in 5. The sizes of the tumors ranged from 4 to 28 cm (mean 12 cm). There were 13 functional tumors with excess hormone production and 8 nonfunctional. Six cases showed evidence of adjacent tissue or lymph node invasion, and 3 cases had developed metastases. Radical curative resection was employed for15 cases, 4 received a palliative operation and 2 only a biopsy.RESULTS All the cases were followed-up for 1 to 5 years. Overall 2 and5-year survival rates were 52.4% (11/21) and 23.8% (5/21), respectively.CONCLUSION Adrenocortical adenocarcinoma appears to have a poor prognosis. Early diagnosis and curative surgery were the most effective treatments.