Using Hallmark collection, GSEA shows that the top genesets positively associated with shorter DFS are G2-M checkpoint genes, mitotic spindle, E2F and myc targets (all FDR < 0.1) These are largely recapitulated by GO functional enrichment analysis, which indicates cell cycle regulation, protein synthesis and ribosome genesis pathways significantly up-regulated in patients with early relapse (all FDR < 0.1) and collectively suggest that ACC progression is marked by both an increased mitotic activity and rates of protein synthesis. This evidence concerns the gene MYC and adrenal cortex carcinoma.