Predictive Factors for Malignant Pheochromocytoma: Analysis of 136 Patients
Predictive Factors for Malignant Pheochromocytoma: Analysis of 136 Patients
复制标题
DOI：
10.1016/j.juro.2010.12.050
复制
发表时间：
2011-05-01
影响因子：
6.6
通讯作者：
Shen, ZhouJun
中科院分区：
文献类型：
--
作者：
Feng, Feng;Zhu, Yu;Shen, ZhouJun
目的：我们评估了临床特征，肿瘤特征和免疫组织化学因素，预测了恶性嗜铬细胞瘤。材料和方法：在1999年1月至2008年12月之间，我们回顾性地回顾了136例Ruijin Hospital在Ruijin Hospital的136例患者。我们比较了临床特征（年龄，性别，症状和生化分析），肿瘤特征（部位，体重和直径）以及3种血管生成/转移相关基因的表达（VEGF，COX，COX-2和MVD），通过免疫组织化学分析pheochromocytomas.sresults：在136例患者中，有105例（77％）的良性和31例（23％）患有恶性嗜性嗜血杆菌。恶性肿瘤比良性肿瘤更大，重，并伴随着较高的血浆肾上腺素分泌（每个P <0.001）。平均肿瘤儿茶酚胺和术前24小时泌尿替甲肾上腺素或Normetanephrine的恶性肿瘤明显高于良性肿瘤（p <0.001）。同样，VEGF的25种恶性肿瘤（81％）是免疫阳性的，而只有24个良性肿瘤（23％）显示出这种特征（p <0.001）。微血管密度和恶性样品中COX-2蛋白的阳性染色速率高于良性样品（p <0.001）。结论：目前可以使用几种有前途的预测参数，以区分良性和恶性体性嗜铬细胞瘤。大型（5厘米或更高）或重（250克或更高）的肿瘤，多焦点和肾上腺外肿瘤，术后早期发作性高血压以及较高的血浆或尿液元肾上腺素是高风险因素，可预测恶性嗜性嗜铬细胞瘤。同样，3种血管生成或转移相关的基因VEGF，COX-2和MVD的表达有助于确定恶性肿瘤的诊断，并提出严格的随访。
Purpose: We evaluated the clinical characteristic, tumor feature and immunohistochemistry factors predicting malignant pheochromocytoma.Materials and Methods: Between January 1999 and December 2008 we retrospectively reviewed the records of 136 patients with pheochromocytoma at Ruijin Hospital. We compared clinical characteristics (age, gender, symptoms and biochemical analysis), tumor features (site, weight and diameter) and the expression of 3 angiogenesis/metastasis related genes (VEGF, Cox-2 and MVD) by immunohistochemical analysis of benign vs malignant pheochromocytomas.Results: Of the 136 patients 105 (77%) had benign and 31 (23%) had malignant pheochromocytoma. Malignant tumors were larger and heavier than benign tumors, and accompanied by higher plasma metanephrine secretion (each p < 0.001). Mean tumor catecholamine and preoperative 24-hour urinary metanephrine or normetanephrine were obviously higher in malignant than in benign tumors (p < 0.001). Also, 25 malignant tumors (81%) were immunopositive for VEGF while only 24 benign tumors (23%) showed this characteristic (p < 0.001). Microvessel density and the rate of positive staining for Cox-2 protein in malignant samples were higher than in benign samples (p < 0.001).Conclusions: Several promising predictive parameters are currently available to distinguish benign from malignant pheochromocytoma. Large (5 cm or greater) or heavy (250 gm or greater) tumors, multifocal and extra-adrenal tumors, early onset postoperative hypertension and higher plasma or urine metadrenaline are high risk factors predictive of malignant pheochromocytoma. Also, expression of the 3 angiogenesis or metastasis related genes VEGF, Cox-2 and MVD helps determine the diagnosis of malignancy and suggests strict followup.