We found that, with the exception of surgery of the primary tumor (no-surgery HR 2.67, p.049), none of the most important ACC prognostic factors (including ENSAT stage, Ki67 value, hormonal hypersecretion) evaluated at initial diagnosis had any impact in predicting PFS of patients submitted to Gem/Cape chemotherapy and were not associated with DSS. This evidence concerns the gene MKI67 and adrenal cortex carcinoma.