Environmental pollution is associated with poorer survival in patients with adrenocortical carcinoma: findings from a national cohort study in Italy

Abstract Background 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. Methods 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 (i) residence in sites officially classified as contaminated (NPCSs: National Priority Contaminated Sites) or in non-contaminated areas; (ii) urbanization, as a contextual proxy for environmental exposure. Outcomes were recurrence-free survival (RFS) and overall survival (OS). Results 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=0.011) and OS (67 vs 142 months; p=0.016) 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=0.016) and death (HR 2.44, 95% CI 1.39–4.28, p=0.002). No significant association was found between the level of urbanization and survival. Conclusions 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.

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Journal
European Journal of Endocrinology
Published
2026-09-25
DOI
https://doi.org/10.1093/ejendo/lvag184
Primary Topic
Adrenal and Paraganglionic Tumors
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article
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article

Environmental pollution is associated with poorer survival in patients with adrenocortical carcinoma: findings from a national cohort study in Italy

Emanuela Arvat, Maria Cristina De Martino, Deborah Cosentini, Massimo Terzolo et al.
European Journal of Endocrinology
Adrenal and Paraganglionic Tumors
article

Environmental pollution is associated with poorer survival in patients with adrenocortical carcinoma: findings from a national cohort study in Italy

Emanuela Arvat, Maria Cristina De Martino, Deborah Cosentini, Massimo Terzolo, Paola Loli, Michaela Luconi, Salvatore Grisanti, Guido Di Dalmazi, Antonio Stigliano, Giuseppe Reimondo, Paola Perotti, Marta Laganà, Filippo Ceccato, Barbara Altieri, Fulvio Ricceri, Serena Palmieri, Soraya Puglisi, Letizia Canu, Erika Messina, Paola Berchialla, Anna Calabrese, Ylenia Alessi, Vittoria Basile, Carla Maria Scaroni, Salvatore Cannavò, Alfredo Berruti, Francesco Ferraù
article en

Abstract

Abstract Background 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. Methods 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 (i) residence in sites officially classified as contaminated (NPCSs: National Priority Contaminated Sites) or in non-contaminated areas; (ii) urbanization, as a contextual proxy for environmental exposure. Outcomes were recurrence-free survival (RFS) and overall survival (OS). Results 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=0.011) and OS (67 vs 142 months; p=0.016) 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=0.016) and death (HR 2.44, 95% CI 1.39–4.28, p=0.002). No significant association was found between the level of urbanization and survival. Conclusions 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.

European Journal of Endocrinology
Università Cattolica del Sacro Cuore (IT), University of Messina (IT), University of Parma (IT), University of Padua (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Ospedale San Carlo (IT), Surgical Specialties (Canada) (CA), Azienda USL di Bologna (IT), University of the Sacred Heart (JP), Department of Public Health (US), University of Florence (IT), University of Turin (IT), University of Naples Federico II (IT), Sapienza University of Rome (IT), University of Bologna (IT)
Sustainable cities and communities
Openalex Percentile: Top 8%
Adrenal and Paraganglionic Tumors
DOIOpen Access PDFOpenAlex
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