Although limited research focusing on the effects of these six hub genes on ACC have been published, we found that lower expression of ACSL4 and higher expression of SLC7A11, TP53, HELLS, PCBP2, and HMGB1 were related to poor OS of patients with ACC in our study, and the underlining mechanism needed further study. This evidence concerns the gene HELLS and adrenal cortex carcinoma.