Tritos N A, Cushing G W, Heatley G, Libertino J A
Section of Endocrinology and Metabolism, Lahey Clinic Medical Center, Burlington, Massachusetts 01805, USA.
Am Surg. 2000 Jan;66(1):73-9.
Adrenocortical carcinoma is a rare tumor associated with a commonly poor prognosis. However, data on the natural history and response to therapy of patients with this malignancy have often been conflicting. Our objective of this retrospective study was to evaluate the clinical course and survival of patients with adrenocortical carcinoma and to identify relevant prognostic factors. Between 1966 and 1996, 31 patients with histologically documented adrenocortical carcinoma were observed at the Lahey Clinic Medical Center. Patient information was obtained from chart review. At the time of diagnosis, 48 per cent of patients had endocrine symptoms with compatible hormonal studies, 19 per cent had involvement of the inferior vena cava by tumor thrombus, and 32 per cent had metastatic disease. The median survival time was 17 months (range, 1-205 months) for the entire group, and the 5-year survival rate was 26 per cent. Age <54 years, absence of metastatic disease at the time of diagnosis, and completeness of surgical resection were associated with better prognosis. Evaluation of survival with the Cox proportional hazards model suggested that age <54 years, absence of metastatic disease, and nonfunctioning tumor status were independently associated with improved survival. The prognosis of patients with adrenocortical carcinoma is poor but appears more favorable in patients <54 years, with localized disease, or nonfunctioning tumor status. Complete tumor resection may be associated with improved survival.
肾上腺皮质癌是一种罕见的肿瘤，其预后通常较差。然而，关于这种恶性肿瘤患者的自然病程和对治疗反应的数据常常相互矛盾。我们这项回顾性研究的目的是评估肾上腺皮质癌患者的临床病程和生存情况，并确定相关的预后因素。1966年至1996年期间，拉希诊所医疗中心观察了31例经组织学证实的肾上腺皮质癌患者。通过查阅病历获取患者信息。诊断时，48%的患者有内分泌症状且激素检查结果相符，19%的患者肿瘤血栓累及下腔静脉，32%的患者有转移性疾病。整个组的中位生存时间为17个月（范围为1至205个月），5年生存率为26%。年龄<54岁、诊断时无转移性疾病以及手术切除的完整性与较好的预后相关。使用Cox比例风险模型评估生存情况表明，年龄<54岁、无转移性疾病以及肿瘤无功能状态与生存改善独立相关。肾上腺皮质癌患者的预后较差，但在年龄<54岁、疾病局限或肿瘤无功能状态的患者中似乎更有利。完整切除肿瘤可能与生存改善相关。
