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PURPOSE Adrenocortical carcinoma (ACC) is a rare condition associated with poor prognosis. This study aimed to evaluate the clinicopathologic characteristics and prognosis of 7 patients with ACC. PATIENTS AND METHODS The clinicopathologic characteristics, treatment, and survival of 7 patients with pathologically confirmed ACC treated at our institution between January 2002 and December 2012 were retrospectively examined. RESULTS The study cohort comprised 4 male and 3 female patients (median age at diagnosis, 63 years [range, 36-71 years]). The median tumor size was 7.0 cm (range, 4.0-13.0 cm), and the median follow-up duration was 22 months (range, 9-107 months). One patient had stage I ACC, 4 had stage III, and 2 showed metastasis. The patient with stage I disease underwent laparoscopic adrenorectomy and those with stage III disease underwent adrenorectomy with the excision of adjacent organs. Four of these 5 patients are alive without recurrence at a median of 55 months (range, 22-107 months) after surgery. Of the 2 patients with metastases, 1 received combined chemotherapy with etoposide, adriamycin, and cisplatin plus mitotane without surgical resection but died 19 months later, and the other, with a solitary lung metastasis, underwent adrenorectomy and metastatectomy followed by adjuvant treatment with mitotane and is alive without recurrence at 9 months after treatment. The 3-year cause-specific survival rate was 56%. CONCLUSIONS Patients with advanced-stage tumors showed long-term survival with complete tumor resection at diagnosis; hence, this seems to be most beneficial treatment option for patients with ACC.

A new C 2 -symmetric diphosphine ligand 8a was readily prepared in one step by treatment of the synthetic precursor of VALAP, 7 , with phthaloyl chloride. Remarkably high levels of asymmetric induction, over 99% ee, were achieved using 8a in palladium-catalyzed asymmetric allylic transformations of sterically less demanding cyclohexenyl substrates 9 . The ligand system was easily extended to the development of analogous chiral auxiliaries 8b , c by the identical procedure but using isophthaloyl chloride and succinyl chloride. However, the ligands 8b , c exhibited much lower catalytic activity. In contrast to the asymmetric allylic substitutions, 8c demonstrated significant improvement of enantioselectivity, up to 64% ee, in rhodium-catalyzed asymmetric hydrosilylations of acetophenone 11a compared to 35% ee using 8a . In this way, the versatility of the present ligand system played an important role in variations of substrates and reaction types.

A new C 2 -symmetric diphosphine ligand 8a was readily prepared in one step by treatment of the synthetic precursor of VALAP, 7 , with phthaloyl chloride. Remarkably high levels of asymmetric induction, over 99% ee, were achieved using 8a in palladium-catalyzed asymmetric allylic transformations of sterically less demanding cyclohexenyl substrates 9 . The ligand system was easily extended to the development of analogous chiral auxiliaries 8b , c by the identical procedure but using isophthaloyl chloride and succinyl chloride. However, the ligands 8b , c exhibited much lower catalytic activity. In contrast to the asymmetric allylic substitutions, 8c demonstrated significant improvement of enantioselectivity, up to 64% ee, in rhodium-catalyzed asymmetric hydrosilylations of acetophenone 11a compared to 35% ee using 8a . In this way, the versatility of the present ligand system played an important role in variations of substrates and reaction types.