Division of General and Endocrine Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
Langenbecks Arch Surg. 2012 Feb;397(2):201-7. doi: 10.1007/s00423-011-0866-8. Epub 2011 Nov 9.
Optimal management of adrenocortical carcinoma (ACC) involves a detailed diagnostic workup, radical surgery, and appropriate adjuvant therapy. However, due to the rarity of this disease, adequate expertise is necessary to ensure optimal patient care. We evaluated if the experience of a treating center influences the outcome of ACC.
Two hundred sixty-three patients who underwent adrenalectomy for ACC were included in a multi-institutional surgical survey and divided into 2 groups: "high-volume center" (HVC) (≥10 adrenalectomies for ACC) and "low-volume center" (LVC) (<10 adrenalectomies for ACC). A comparative analysis was performed.
One hundred seventy-two patients underwent adrenalectomy at HVC and 91 at LVC. The two groups were homogeneous for age, sex, clinical presentation, and stage. The mean lesions size of ACC was higher in HVC than in LVC (104.1 ± 54.6 vs 82.8 ± 41.3 mm; P < 0.001). A significantly higher rate of lymph node dissection (P < 0.01) and of multiorgan resection (P < 0.01) was accomplished in HVC. The number of patients who underwent adjuvant therapy was significantly higher in HVC (P < 0.001). Local recurrence rate was lower in patients treated at HVC (6% vs 18.5%; P = NS). Mean time to recurrence was significantly longer in HVC than in LVC (25.2 ± 28.1 vs 10.1 ± 7.5; P < 0.01).
The expertise of dedicated centers had a positive impact on the outcome of patients with ACC, resulting in a lower recurrence rate and improved mean time to recurrence. The improved patient outcome could be related not only to the appropriateness of the surgical procedure, but also to a more adequate multidisciplinary approach.
肾上腺皮质癌（ACC）的最佳治疗需要详细的诊断检查、根治性手术和适当的辅助治疗。然而，由于这种疾病罕见，需要有足够的专业知识才能确保为患者提供最佳治疗。我们评估了治疗中心的经验是否会影响 ACC 的治疗效果。
对 263 名接受肾上腺切除术治疗 ACC 的患者进行了多机构手术调查，并将其分为 2 组：“高容量中心”（HVC）（≥10 例 ACC 肾上腺切除术）和“低容量中心”（LVC）（<10 例 ACC 肾上腺切除术）。对这两组进行了对比分析。
172 名患者在 HVC 进行了肾上腺切除术，91 名患者在 LVC 进行了肾上腺切除术。两组患者的年龄、性别、临床表现和分期均相似。HVC 中 ACC 的平均肿瘤大小大于 LVC（104.1 ± 54.6 与 82.8 ± 41.3 mm；P < 0.001）。HVC 中完成淋巴结清扫术（P < 0.01）和多器官切除术（P < 0.01）的比例明显更高。HVC 中接受辅助治疗的患者数量明显更多（P < 0.001）。HVC 中局部复发率较低（6%比 18.5%；P = NS）。HVC 中复发的平均时间明显长于 LVC（25.2 ± 28.1 与 10.1 ± 7.5；P < 0.01）。
专门中心的专业知识对 ACC 患者的治疗效果产生了积极影响，降低了复发率并提高了复发的平均时间。患者预后的改善不仅与手术的适当性有关，还与更充分的多学科治疗方法有关。
