Response rates to radiotherapy have been reported up to 42%.[38,39] In fact, the German ACC team recommends that adjuvant radiotherapy be applied for lesions of stage III or of indeterminate resection margins following resection.[39] In addition, PD-1, an immunoinhibitory receptor, has shown the ability to function as a marker for tumor prognosis.[40,41] To date, the PD-1 and programmed death-ligand 1 (PD-L1) expression in ACCs and its prognostic significance are still uncertain. This evidence concerns the gene PDCD1 and adrenal cortex carcinoma.