肾上腺皮质癌术后复发再手术切除的疗效和预后因素分析  

Analysis of curative effect and prognostic factors of reoperation for postoperative recurrence of adrenal cortical carcinoma

作　　者：杨华安 李志勇 郭胜杰[1] 尧凯[1] 李永红[1] 叶云林[1] 王延军[1] 陈东[1] 吴志明[1] 董培[1] 张志凌[1] 刘卓炜[1] 秦自科[1] 韩辉[1] 周芳坚[1] YANG Hua′an;LI Zhiyong;GUO Shengjie;YAO Kai;LI Yonghong;YE Yunlin;WANG Yanjun;CHEN Dong;WU Zhiming;DONG Pei;ZHANG Zhiling;LIU Zhuowei;QIN Zike;HAN Hui;ZHOU Fangjian(Department of Urology,Sun Yat-Sen University Cancer Center,Guangzhou 510060,China;Department of Urology,the Public Hospital of Yubei District in Chongqing,Chongqing 401120,China;不详)

机构地区：[1]中山大学肿瘤防治中心泌尿外科,广州510060 [2]重庆市渝北区人民医院泌尿外科,重庆401120

出　　处：《实用医学杂志》2020年第16期2220-2224,共5页The Journal of Practical Medicine

基　　金：广东省科技计划项目(编号:2017A020215150)。

摘　　要：目的探讨肾上腺皮质癌(ACC)术后复发再手术治疗的临床价值和预后因素。方法收集2000年4月至2017年12月在中山大学肿瘤防治中心诊治的38例ACC术后复发患者临床资料进行回顾性分析。采用Kaplan-Meier分析计算中位生存时间、Log-rank检验比较各组间生存差异、单因素及多因素Cox回归模型计算风险比(HR)及95%置信区间(95%CI)。结果38例患者中男22例(57.9%),女16例(42.1%),平均年龄(48.5±12.0)岁,原位复发14例(36.8%),远处转移24例(63.2%)。手术切除23例(其中扩大切除13例),15例未手术。平均随访时间(25.5±24.4)个月。原位复发和远处转移患者平均生存时间分别为(29.0±3.1)个月和(13.0±6.0)个月(P<0.05),5年生存率分别为26.5%和10.9%。13例行手术切除的原位复发患者中,9例扩大切除患者的平均生存时间为(32.0±3.6)个月,4例非扩大手术切除患者的平均生存时间为(13.0±2.5)个月(P=0.018)。10例远处转移患者接受手术治疗,平均生存时间为(7.0±0.7)个月;14例未手术的远处转移患者平均生存时间为(13±5.2)个月(P=0.852)。高乳酸脱氢酶患者死亡风险是非高乳酸脱氢酶患者的4.596倍(HR=4.59695%CI:1.911~10.924,P=0.001)。结论对ACC术后原位复发患者复发灶行扩大切除可改善患者生存,但远处转移患者原位复发病灶的切除对患者生存无获益。高乳酸脱氢酶是ACC术后复发患者预后的独立预后因素。Objective To investigate the clinical value and prognostic factors about the reoperation of postoperative recurrence in adrenocortical carcinoma.Methods The clinical data of 38 patients with postoperative recurrence of adrenocortical carcinoma were retrospectively analyzed from April 2000 to December 2017.The median survival time was calculated by Kaplan-Meier analysis.Log-rank tests were used to compare survival differences.The single-factor and multi-factor Cox regression model was used to calculate the risk ratio(HR)and 95%confidence interval(95%CI).Results Among the 38 patients,22 were males(57.9%),16 were females(42.1%),the mean age was(48.5±12.0)(24-72)years,14 in situ recurrence(36.8%)and 24 distantly metastasis(63.2.%).Surgical resection was performed in 23 cases(of which expanded resection was performed in 13 cases)and 15 without surgery.Average follow-up time was(25.5±24.4)months.The median survival time was(29.0±3.1)months and(13.0±6.0)months(P<0.05)in patients with in situ recurrence and distant metastasis.The 5-year survival rate was 26.5%and 10.9%respectively.The mean survival time was(32.0±3.6)months for 9 patients undergoing surgical resection and(13.0±2.5)months(P=0.018)for 4 patients undergoing surgical resection.The median survival time of 10 patients with distant metastasis was(7.0±0.7)months,and that of non-operative patients with distant metastasis was(13±5.2)months(P=0.852).Death risk in patients with high lactate dehydrogenase is4.596 times higher than that in patients with non-high lactate dehydrogenase(HR=4.59695%CI:1.911~10.924,P=0.001).Conclusions Extended resection of recurrent foci in patients with adrenocortical carcinoma after operation can improve survival,but resection of situ recurrent foci in patients with distant metastasis has no benefit for survival.High lactate dehydrogenase is an independent prognostic factor for postoperative recurrence of adrenocortical carcinoma.

关 键 词：肾上腺皮质癌 扩大切除 复发 预后 

分 类 号：R586.9[医药卫生—内分泌]