Adrenocortical carcinomas: Surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group
Adrenocortical carcinomas: Surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group
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DOI：
10.1007/s00268-001-0047-y
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发表时间：
2001-07-01
影响因子：
2.6
通讯作者：
Proye, C
中科院分区：
文献类型：
--
作者：
Icard, P;Goudet, P;Proye, C
由于肾上腺皮质癌的罕见性，接受手术的患者的存活率和预后尚不清楚。法国内分泌外科协会的目的是在18年的时间内评估这些因素。一项相关的趋势研究评估了临床和生化表现的变化以及手术进展。共纳入253例患者（158例女性，95例男性），平均年龄为47岁。库欣综合征是主要的临床表现（30%），激素研究显示66%的病例有分泌性肿瘤。总的来说，72%（n = 182）的患者接受了根治性切除术，其中41.5%（n = 105）的患者因转移癌而接受了广泛切除术。32.5%（n = 89）的病例进行了淋巴结切除术。手术死亡率为5.5%（n = 14）。53.8%的患者（n = 135）接受了米托坦辅助治疗，16例患者的分期结果为I期（6.3%），II期（局部疾病）126例（49.8%），III期（局部区域疾病）57例54例患者（21.3%）为IV期（转移）。在研究期间，肿瘤分期和根治性手术率均未发生变化。更多的肋下切口，米托坦的使用显着增加。总体5年生存率为38%，治疗组为50%，I期为66%，II期为58%，III期为24%，TV期为0%。多变量分析显示米托坦仅对未手术治愈的患者组有益。1988年以后手术的患者预后较好（p = 0.04），肿瘤分泌型患者预后较好（p = 0.005），疾病处于局部阶段的患者预后较好（p = 0.0003），因此米托坦仅对未手术治疗的患者有益。治愈性切除、前体分泌、近期诊断和局部分期与生存率有利相关。
Because of the rarity of adrenocortical carcinoma, survival rates and the prognosis for patients who have undergone operation are not well known. The purpose of the French Association of Endocrine Surgery was to evaluate these factors over an 18-year period. A trend study was associated to assess changes in the clinical and biochemical presentations as well as the surgical evolution. A total of 253 patients (158 women, 95 men) with a mean age of 47 years were included. Cushing syndrome was the main clinical presentation (30%), and hormonal studies revealed secreting tumors in 66% of the cases. Altogether, 72% (n = 182) of patients underwent resection for cure, and 41.5% (n = 105) of them had an extensive resection because of metastatic cancer. A lymphadenectomy was performed in 32.5% (n = 89) of the cases. The operative mortality was 5.5% (n = 14). Patients were given mitotane as adjuvant therapy in 53.8% of the cases (n = 135), The results of staging were stage I in 16 patients (6.3%), stage II (local disease) in 126 patients (49.8%), stage III (locoregional disease) in 57 patients (22.5%), and stage IV (metastases) in 54 patients (21.3%), Neither tumor staging nor the rate of curative surgery changed during the study period. More subcostal incisions were performed, and the use of mitotane increased significantly. The 5-year actuarial survival rates were 38% overall, 50% in the curative group, 66% for stage I, 58% for stage II, 24% for stage III, and 0% for stage TV. Multivariate analysis showed that mitotane benefited only the group of patients not operated on for cure. A better prognosis was found in patients operated on after 1988 (p = 0.04), in those with precursor-secreting tumors (p = 0.005), and in those at local stages of the disease (p = 0.0003), Thus mitotane benefited only patients not operated on for cure. Curative resection, precursor secretion, recent diagnosis, and local stage were favorably associated with survival.