Operative management for recurrent and metastatic adrenocortical carcinoma.
Operative management for recurrent and metastatic adrenocortical carcinoma.
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DOI：
10.1002/jso.23015
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发表时间：
2012-06-01
影响因子：
2.5
通讯作者：
Avital, Itzhak
中科院分区：
文献类型：
--
作者：
Datrice, Nicole M.;Langan, Russell C.;Ripley, R. Taylor;Kemp, Clinton D.;Steinberg, Seth M.;Wood, Bradford J.;Libutti, Steven K.;Fojo, Tito;Schrump, David S.;Avital, Itzhak
对所有复发或转移性ACC的切除进行回顾，以确定哪些患者可能从外科手术中受益，并确定可能有助于转移性疾病患者预后的因素。肾上腺皮质癌(ACC)是一种罕见的肿瘤，即使在完全切除后也经常复发和转移。化疗的疗效有限，手术切除转移性ACC仍然存在争议。对1977-2009年间在同一三级中心接受手术治疗的所有转移性ACC患者进行了回顾性研究。分析所有可用的临床病理数据，以确定与治疗反应和生存相关的潜在因素。57名患者因复发或转移性疾病接受了116次手术。23例为肝转移，48例为肺转移，22例为腹部疾病，包括局部复发，13例为其他部位转移。首次转移瘤切除后的中位和5年生存率分别为2.5年和41%。DFI+12个月患者的中位生存期为1.7年，DFI+GT；12个月患者的中位生存期为6.6年(P=0.015)。右侧与左侧的中位生存期分别为1.9年和3.8年(P=0.03)。右侧原发灶的肝转移更常见(67%比41%，P=0.05)。化疗对存活率没有影响。切除复发或转移的ACC是安全的，并可能导致部分DFI患者的生存期延长1年以上。
A review of all resections for recurrent or metastatic ACC was performed to identify patients who might benefit from a surgical approach, and to identify factors that might aid in prognosis among patients with metastatic disease. Adrenocortical carcinoma (ACC) is a rare tumor, with frequent recurrences and metastases even after complete resection. Chemotherapy has limited efficacy, and surgical resection of metastatic ACC remains controversial. A retrospective review was performed of all patients who underwent surgical intervention for metastatic ACC in a single tertiary center from 1977 to 2009. All available clinicopathologic data were analyzed to determine potential factors associated with response to treatment and survival. Fifty-seven patients underwent 116 procedures for recurrent or metastatic disease. Twenty-three resections were for liver metastases, 48 for pulmonary metastases, 22 for abdominal disease including local recurrences, and 13 were for metastases at other sites. Median and 5-year survivals from time of first metastasectomy were 2.5 years, and 41%, respectively. The median survival of patients with DFI <12 months was 1.7 years, compared to 6.6 years for patients with DFI >12 months (P = 0.015). Median survival for right versus left-sided primaries was 1.9 years versus 3.8 years (P = 0.03). Liver metastases were more common with right-sided primaries (67% vs. 41%, P = 0.05). Chemotherapy had no impact on survival. Resection of recurrent or metastatic ACC is safe, and may result in prolongation of survival in selected patients with DFI greater than 1 year.
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影响因子：
2.5
作者：
ZOGRAFOS, GC;DRISCOLL, DL;HUBEN, RP
通讯作者：
HUBEN, RP
影响因子：
3.7
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Schulick, RD;Brennan, MF
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8.8
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Haak, H. R.;Hermans, J.;Van De Velde, C. J. H.;Lentjes, E. G. W. M.;Goslings, B. M.;Fleuren, G.-J.;Krans, H. M. J.
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Krans, H. M. J.
影响因子：
3.1
作者：
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通讯作者：
Demeure, Michael J.
影响因子：
158.5
作者：
LUTON, JP;CERDAS, S;BRICAIRE, H
通讯作者：
BRICAIRE, H