肺切除术治疗转移性肾上腺皮质癌：美国国家癌症研究所经验。
Pulmonary resection for metastatic adrenocortical carcinoma: the National Cancer Institute experience.
机构信息
Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
出版信息
Ann Thorac Surg. 2011 Oct;92(4):1195-200. doi: 10.1016/j.athoracsur.2011.05.013.
BACKGROUND
Adrenocortical carcinoma (ACC) is a rare neoplasm with a high propensity for locoregional recurrences and distant metastases for which there are no effective systemic therapies. This study was undertaken to determine outcomes of patients undergoing pulmonary metastasectomy for ACC.
METHODS
A single-institution retrospective review was performed of patients undergoing pulmonary metastasectomy for ACC from 1979 to 2010.
RESULTS
Twenty-six patients underwent 60 pulmonary metastasectomies. Fifteen patients (58%) underwent unilateral thoracotomy, 6 (23%) had staged thoracotomies, and 5 (19%) underwent median sternotomy as the initial thoracic procedure. Median number and size of lesions were 6 and 2 cm, respectively. Twenty-three patients (88%) were rendered free of disease in the lung, and 14 (54%) were rendered completely free of disease. Median overall and 5-year actuarial survivals from initial pulmonary metastasectomy were 40 months and 41%, respectively, with a median potential follow-up of 120 months. Median recurrence-free survival (RFS) and 5-year RFS for ipsilateral thoracic recurrences were 6 months, and 25%, respectively. The median RFS in the contralateral thorax was 5 months. Time to first recurrence after adrenalectomy and T stage of the primary tumor, but not adjuvant or neoadjuvant chemotherapy, were associated with increased overall survival after pulmonary metastasectomy.
CONCLUSIONS
This study represents the most comprehensive review of outcomes of patients undergoing pulmonary metastasectomy for ACC. Given the lack of effective systemic therapies, pulmonary metastasectomy may be beneficial in properly selected patients.
背景
肾上腺皮质癌（ACC）是一种罕见的肿瘤，局部复发和远处转移的倾向很高，目前尚无有效的全身治疗方法。本研究旨在确定接受肺转移瘤切除术治疗 ACC 患者的结局。
方法
对 1979 年至 2010 年期间在我院接受肺转移瘤切除术治疗的 ACC 患者进行了单中心回顾性研究。
结果
26 例患者共行 60 例肺转移瘤切除术。15 例（58%）患者接受单侧开胸术，6 例（23%）患者接受分期开胸术，5 例（19%）患者初始采用正中开胸术进行胸部手术。病灶的中位数个数和大小分别为 6 个和 2cm。23 例（88%）患者肺部无疾病残留，14 例（54%）患者完全无疾病残留。初始肺转移瘤切除术的中位总生存时间和 5 年生存率分别为 40 个月和 41%，中位潜在随访时间为 120 个月。同侧胸内复发的中位无复发生存时间（RFS）和 5 年 RFS 分别为 6 个月和 25%。对侧胸内的中位 RFS 为 5 个月。肾上腺切除术的时间和原发肿瘤的 T 分期与肺转移瘤切除术后的总生存时间延长有关，而辅助或新辅助化疗与肺转移瘤切除术后的总生存时间延长无关。
结论
本研究是对接受肺转移瘤切除术治疗 ACC 患者结局的最全面的回顾。鉴于缺乏有效的全身治疗方法，肺转移瘤切除术可能对选择合适的患者有益。
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