Changes in clinical features and long-term prognosis in patients with pheochromocytoma
Changes in clinical features and long-term prognosis in patients with pheochromocytoma
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DOI：
10.1016/s0895-7061(99)00139-9
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发表时间：
2000-01-01
影响因子：
3.2
通讯作者：
Miura, Y
中科院分区：
文献类型：
--
作者：
Noshiro, T;Shimizu, K;Miura, Y
为了研究嗜铬细胞瘤患者术前临床特征的变化以及肿瘤复发、死亡率和发病率的长期预后，我们回顾性地比较了1957年至1985年49例患者（第一组）和1986年至1995年12月46例患者（第二组）的临床特征变化。此外，在这95例患者中（不包括2例术前死亡的患者），我们评估了从首次手术到1996年8月（909患者年）的长期术后结果。II组的平均年龄比i组大。II组有蛋白尿或高血压性视网膜病变的患者比例少于i组。在20例偶然发现嗜铬细胞瘤的患者中，大于等于60岁的有7例（35%），无症状的有7例，血压正常的有11例（55%）。与具有典型临床特征的嗜铬细胞瘤患者相比，这些患者血浆和尿儿茶酚胺含量显著（P < 0.01）降低。长期队列研究显示有14人死亡。5年和10年的相对生存率分别为91%和83%，此后没有变化。在肿瘤重量大于中位数（60 g）的患者中，Kaplan-Meier估计无嗜铬细胞瘤生存期较短。6例患者术后3 ~ 101个月（中位45个月）恶性复发。随访时确认存活的65例患者中，有2例为高血压。在Cox模型中，无高血压生存与年龄、高血压家族史、高血压持续时间或肌酐清除率无关。嗜铬细胞瘤应从广泛的临床特征进行诊断，包括那些通常不被怀疑是由过量儿茶酚胺或高血压引起的临床特征，由于肿瘤复发的风险和疾病的高患病率，手术后，患者应长期（至少10年）仔细随访。(C) 2000中国高血压杂志
To investigate changes in preoperative clinical features and the long-term outcome of tumor recurrence, mortality, and morbidity in patients with pheochromocytoma, we retrospectively examined changes in the clinical features by comparing 49 patients from 1957 to 1985 (group I) with 46 patients from 1986 to December 1995 (group II). In addition in these 95 patients (excluding 2 who had died before operation), we evaluated long-term postoperative outcome from the initial operation to August 1996 (909 patient-years). The mean age in group II was older than that of group I. The percentage of patients having proteinuria or hypertensive retinopathy in group II was less than that in group I. Of 20 patients with incidentally discovered pheochromocytoma, 7 (35%) were greater than or equal to 60 years old, 7 asymptomatic, and 11 (55%) normotensive. Plasma and urinary catecholamines in these patients were significantly (P < .01) lower than in patients with pheochromocytoma having typical clinical features. Long-term cohort study showed 14 deaths. Relative survival rates were 91% at 5 years and 83% at 10 years and unchanged thereafter. The Kaplan-Meier estimate of pheochromocytoma-free survival was shorter in patients with a larger-than-median (60 g) tumor weight. Six patients had malignant recurrence 3 to 101 months (median, 45 months) after the initial operation. Of 65 patients confirmed alive at follow-up, II were hypertensive. In the Cox model hypertension-free survival was not associated with age, a family history of hypertension, duration of hypertension, or creatinine clearance.Pheochromocytoma should be diagnosed from a wide spectrum of clinical features including those that are not generally suspected of resulting from excess catecholamines or hypertension, and after surgery, patients with this disease should be followed-up carefully for a long period (at least 10 years) because of the risk of tumor recurrence and the high prevalence of disease. (C) 2000 American Journal of Hypertension, Ltd.