Nishida Sachiyo, Itoh Naoki, Sasao Takumi, Masumori Naoya, Taguchi Keisuke, Tsukamoto Taiji
Department of Urology, Sapporo Medical University School of Medicine, Minami-1, Nishi-16, Chuo-ku, Sapporo 060-8543, Japan.
Int J Urol. 2007 Jul;14(7):581-4. doi: 10.1111/j.1442-2042.2007.01792.x.
To review clinical outcome of patients with adrenocortical carcinoma experienced at a single institute over 34 years.
The study included 14 patients who were diagnosed as having the disease and were treated at the Department of Urology, Sapporo Medical University Hospital between 1973 and 2006. Their clinical features and outcomes were reviewed.
Of the 14 patients, there were nine men and five women. The median follow-up period was 13.0 months (range, 1-213). Two patients were classified as having stage II disease, seven as stage III and five as stage IV. The disease was completely removed in eight patients and incompletely in three. Two other patients received exploratory laparotomy only. The remaining one patient had no indication for surgery. The median survival periods were 2 months in patients with stage IV and 108 months in those with stages II and III (P = 0.136). Mitotane treatment in the adjuvant setting did not clearly affect the clinical courses of patients without metastasis. However, the treatment was effective for metastasis that was repeatedly developed as late recurrence in one patient. Three patients with metastasis at diagnosis received combination chemotherapy with etoposide, doxorubicin and cisplatin (EDP) with or without mitotane treatment, to which lung metastasis completely responded in one patient.
Adrenocortical carcinoma is a rare disease but frequently recurs. The best chance of survival may be achieved by early detection and complete surgical removal. There may be patients who possibly benefit from mitotane treatment with or without EDP, although this remains to be conclusively determined.
回顾一家机构34年间肾上腺皮质癌患者的临床结局。
本研究纳入了1973年至2006年间在札幌医科大学医院泌尿外科被诊断患有该病并接受治疗的14例患者。对他们的临床特征和结局进行了回顾。
14例患者中，男性9例，女性5例。中位随访期为13.0个月（范围1 - 213个月）。2例患者被归类为Ⅱ期疾病，7例为Ⅲ期，5例为Ⅳ期。8例患者肿瘤被完全切除，3例未完全切除。另外2例患者仅接受了探查性剖腹手术。其余1例患者无手术指征。Ⅳ期患者的中位生存期为2个月，Ⅱ期和Ⅲ期患者为108个月（P = 0.136）。在辅助治疗中使用米托坦对无转移患者的临床病程没有明显影响。然而，该治疗对1例患者后期反复发生的转移有效。3例诊断时有转移的患者接受了依托泊苷、阿霉素和顺铂（EDP）联合化疗，联合或不联合米托坦治疗，其中1例患者的肺转移完全缓解。
肾上腺皮质癌是一种罕见疾病，但经常复发。早期发现并完全手术切除可能获得最佳生存机会。部分患者可能从米托坦联合或不联合EDP治疗中获益，尽管这一点仍有待最终确定。
