Abstract: Objective To investigate the clinical features and prognostic determinants of adrenocortical carcinoma (ACC) in adult patients. Methods All adult patients (aged≥18 years old) who were admitted to West China Hospital, Sichuan University from 1st Jan., 2000 to 31st Jan., 2013 with a pathologically diagnosed ACC were included in this study. Data about the demographics, clinical characteristics, laboratory examinations and outcomes of those patients were extracted and analyzed. Results A total of 52 cases were identified, with a median follow-up of 26 months (3-159 months). The patients had a median survival time of 29 months (1-156 months), with a 1-year, 3-year, and 5-year survival rate of 71.0%, 47.0%, and 42.7%, respectively. In the univariate analysis, aged >45 years old at diagnosis (\P=0.017), advanced stage (Ⅲ-Ⅳ stage, \P\P=0.011), symptomatic (\P=0.017), hypoalbuminemia (\P=0.003), and elevated lactate dehydrogenase (LDH) (\P=0.017) were associated with poor prognosis of ACC. The multivariate analysis confirmed that hypoalbuminemia 〔hazard ratio (\HR)=5.306; 95% confidence interval (95%\CI: 1.975, 14.258; \P=0.001〕, female (\HR=4.020; 95%\CI: 1.610, 10.038; \P=0.003), advanced stage (\HR=7.405; 95%\CI: 2.561, 21.410; \P\HR=4.628; 95%\CI: 1.791, 11.959; \P=0.002) were predictors of poor prognosis of ACC. Conclusion Hypoalbuminemia, female, older age, and advanced stage are independent risk factors associated with poor prognosis of ACC in adult patients.