Objective: The study aimed to analyze clinicopathological features, treatment outcomes, and prognostic factors of patients with adrenocortical carcinoma (ACC). Material and Methods: The records of 25 patients with confirmed ACC were retrospectively examined who were followed up in our clinic. The clinical and pathological data were recorded. The prognosis was estimated using the Kaplan- Meier method, and prognostic variables were determined using Cox regression models. Results: The study included 21 patients, 19 (90.5%) of whom initially had Stage III or IV disease, and 18 (85.7%) had surgery for the primary tumor. In the subgroup with non-metastatic disease and primary tumor resection, patients who received adjuvant mitotane had significantly longer median disease-free survival than patients who had not (22.7 vs. 2.5 months, p=0.02). Five-year overall survival (OS) was 36%. De novo metastatic disease, primary tumor resection, and tumor functional status were the factors affecting OS significantly or having a trend in univariate analysis. Primary tumor resection was the only independent prognostic factor for OS after adjusting for other factors (hazard ratio=0.06, p=0.04). Conclusion: In our study population, adjuvant mitotane conferred a significant improvement in disease-free survival of patients with ACC who were operated on for localized disease. Primary tumor resection persisted in being a significant prognostic factor for OS.