非小细胞肺癌并发孤立性肾上腺转移患者手术疗效的系统回顾及pooled分析  

Outcomes of surgical treatment for patients with non-small- cell lung cancer complicated with isolated adrenal metastasis:A systematic review and pooled analysis

作　　者：高新亮[1] 付彤[2] 张科伟[1] 李洋[1] 张克剑[1] 贾腾[1] 刘灏 刘伟[1] 

机构地区：[1]吉林大学第一医院胸外科,吉林长春130021 [2]吉林大学第一医院乳腺外科,吉林长春130021 [3]内蒙古自治区通辽市中心医院胸外科,内蒙古通辽028000

出　　处：《吉林大学学报（医学版）》2014年第2期345-350,共6页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(81272607);吉林省科技厅科研基金资助课题(20110734)

摘　　要：目的：对非小细胞肺癌（NSCLC）并发孤立性肾上腺转移患者的手术疗效进行系统回顾及pooled分析，为手术治疗NSCLC并发孤立性肾上腺转移提供依据。方法：检索1990年1月-2013年1月发表在PubMed和ScienceDirect数据库中与NSCLC并发孤立性。肾上腺转移手术治疗相关的回顾性研究文献，并进行pooled分析。结果：纳入符合筛选标准的文献11篇，含87例患者，均行肺叶或全肺切除术和肾上腺手术治疗，术后患者平均生存期为41个月（95％CI，30．6～51．3个月）；中位生存期为16个月（95％CI，9～23个月），1、2和5年生存率分别为64．0％、37．7％和29．2％。单因素预后分析，异时性肾上腺转移（MAM）患者预后明显优于同时性转移（SAM）者，2组患者1、2和5年生存率分别为80．5％和46．8％、52．3％和22．％及35．0％和22．5％，中位生存期分别为31个月和12个月；而不同病理类型的原发性肺癌（鳞癌和腺癌）、纵隔淋巴结转移与否和肾上腺转移灶位置（与原发灶同侧或对侧）等因素与患者预后无关联。结论：部分NSCLC并发孤立性肾上腺转移患者经肺部手术及肾上腺切除术治疗后可以获得长期生存，而且MAM患者预后好于SAM患者。Objective To evaluate the outcomes of surgical treatment for the patients with non-small-cell lung cancer （NSCLC） complicated with isolated adrenal metastasis with a systematic review and pooled analysis, and to provide an evidence for surgical treatment of NSCLC complicated with isolated adrenal metastasis. Methods A search for publications on surgical treatment for NSCLC complicated with isolated adrenal metastasis from January 1990 to January 2013 was performed via the PubMed and ScienceDirect. The retrospective studies were expected to be included in Pooled analysis. Results 11 studies including 87 patients who had received lung resection and adrenalectomy were selected. The mean survival time of the patients after operation was 41 months （95~ CI, 30.6--51.3 months）, and the median overall survival was 16 months （95~CI, 9--23 months）. The 1 year, 2-year, and 5 year survival rates were 64.0~, 37.7~, and 29.2%, respectively. In univariate analysis, the prognosis of the patients with synchronous adrenal metastasis （SAM） was worse than those with metachronous adrenal metastasis（MAM）, and the median overall survival was 12 months vs 31 months; the i-year survival rates were 80.5% and 46.8%, the 2-year survival rates were 52.3% and 22. %, and the 5-year survival rates were 35.0% and 22.5%. However, the pathology of primary lung cancer（squamous carcinoma and adenocarcinoma）, the mediastinum lymph node or not and the position （ipsilateral or contralateral） of adrenal metastasis were not the prognostic factors. Conclusion Parts of the patients with NSCLC complicated with isolated adrenal metastasis after lung resection and adrenalectomy have a long survival. The patients with MAM have a better survival than the SAM patients.

关 键 词：癌 非小细胞肺 肿瘤转移 肾上腺切除术 

分 类 号：R655.3[医药卫生—外科学]