Liver Resection and Ablation for Metastatic Adrenocortical Carcinoma
Liver Resection and Ablation for Metastatic Adrenocortical Carcinoma
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DOI：
10.1245/s10434-011-1564-z
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发表时间：
2011-07-01
影响因子：
3.7
通讯作者：
Avital, Itzhak
中科院分区：
文献类型：
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作者：
Ripley, R. Taylor;Kemp, Clinton D.;Avital, Itzhak
背景肾上腺皮质癌是一种罕见的疾病，没有有效的化疗治疗最适当的切除。本研究的目的是评估我们的经验，肝切除转移性ACC。本研究回顾性分析了1979年至2009年接受肝切除或射频消融（RFA）治疗ACC的患者。共识别出27例患者。27例中，19例接受了肝切除术。19例中，10例有单一肝脏病变，19例中有18例肝脏无疾病，尽管19例中只有11例因肝外疾病（EHD）而完全无疾病。在这19例患者中，13例同时患有EHD。此外，在中位随访6.2年时，17例患者中有6例肝脏无疾病（19例患者中有2例状态未知）。27例患者中，8例接受了RFA，7/8例肝脏无疾病，5/7例接受了EHD。没有患者对既往化疗有反应。接受肝切除术或RFA的患者的中位总生存期和生存期均为1.9年（0.2-12 +年）; 5年精算生存率分别为29%和29%。初次切除后无病期（DFI）大于9个月与较长的生存期相关（中位数4.1 vs 0.9年; P = 0.013）。本研究是一项针对ACC的肝切除术和RFA的三级机构系列研究。鉴于缺乏有效的全身治疗选择以及切除和消融的安全性，在选定的ACC转移至肝脏的患者（尤其是DFI较长的患者）中，可以考虑肝切除术或RFA。
Background. Adrenocortical carcinoma (ACC) is a rare disease without effective chemotherapy treated most appropriately with resection. The aim of this study was to evaluate our experience with liver resection for metastatic ACC.Methods. This study is a retrospective review of patients who underwent liver resection or radiofrequency ablation (RFA) for ACC from 1979 to 2009.Results. A total of 27 patients were identified. Of the 27, 19 underwent liver resection. Of the 19, 10 had a single liver lesion, and 18 of 19 were rendered free of disease in the liver, although only 11 of 19 were rendered completely free of disease because of extrahepatic disease (EHD). Of the 19, 13 had synchronous EHD. Also, 6 of 17 remained disease free in the liver at a median follow-up of 6.2 years (status of 2 of 19 was unknown). Of the 27 patients, 8 underwent RFA, 7 of 8 became free of disease in the liver, and 5 of 7 had EHD. No patients responded to prior chemotherapy. Median overall survival and survival of patients who underwent liver resection or RFA were both 1.9 years (0.2-12 + years); 5-year actuarial survivals were 29% and 29%, respectively. Disease-free interval (DFI) greater than 9 months from primary resection was associated with longer survival (median 4.1 vs 0.9 years; P = .013).Conclusions. This study is a tertiary institution series of liver resection and RFA for ACC. Given the lack of effective systemic treatment options and the safety of resection and ablation, liver resection or RFA may be considered in selected patients with ACC metastatic to the liver especially with a long DFI.