复发性和转移性肾上腺皮质癌的手术治疗。

Operative management for recurrent and metastatic adrenocortical carcinoma.

机构信息

Surgery Branch, National Cancer Institute/NIH, Building 10-Hatfield CRC Room 4-3961, 10 Center Drive, Bethesda, MD 20892, USA.

出版信息

J Surg Oncol. 2012 Jun 1;105(7):709-13. doi: 10.1002/jso.23015. Epub 2011 Dec 20.

DOI:10.1002/jso.23015

PMID:22189845

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4136651/

Abstract

OBJECTIVE

A review of all resections for recurrent or metastatic ACC was performed to identify patients who might benefit from a surgical approach, and to identify factors that might aid in prognosis among patients with metastatic disease.

SUMMARY BACKGROUND DATA

Adrenocortical carcinoma (ACC) is a rare tumor, with frequent recurrences and metastases even after complete resection. Chemotherapy has limited efficacy, and surgical resection of metastatic ACC remains controversial.

METHODS

A retrospective review was performed of all patients who underwent surgical intervention for metastatic ACC in a single tertiary center from 1977 to 2009. All available clinicopathologic data were analyzed to determine potential factors associated with response to treatment and survival.

RESULTS

Fifty-seven patients underwent 116 procedures for recurrent or metastatic disease. Twenty-three resections were for liver metastases, 48 for pulmonary metastases, 22 for abdominal disease including local recurrences, and 13 were for metastases at other sites. Median and 5-year survivals from time of first metastasectomy were 2.5 years, and 41%, respectively. The median survival of patients with DFI <12 months was 1.7 years, compared to 6.6 years for patients with DFI >12 months (P = 0.015). Median survival for right versus left-sided primaries was 1.9 years versus 3.8 years (P = 0.03). Liver metastases were more common with right-sided primaries (67% vs. 41%, P = 0.05). Chemotherapy had no impact on survival.

CONCLUSIONS

Resection of recurrent or metastatic ACC is safe, and may result in prolongation of survival in selected patients with DFI greater than 1 year.

摘要

目的

对所有复发性或转移性 ACC 的切除术进行回顾性研究，以确定可能从手术治疗中获益的患者，并确定转移性疾病患者的预后因素。

摘要背景数据

肾上腺皮质癌（ACC）是一种罕见的肿瘤，即使在完全切除后也经常复发和转移。化疗疗效有限，转移性 ACC 的手术切除仍然存在争议。

方法

对 1977 年至 2009 年在一家三级中心接受转移性 ACC 手术干预的所有患者进行回顾性分析。分析所有可获得的临床病理数据，以确定与治疗反应和生存相关的潜在因素。

结果

57 例患者共进行了 116 次治疗复发性或转移性疾病的手术。23 例为肝转移切除术，48 例为肺转移切除术，22 例为腹部疾病切除术（包括局部复发），13 例为其他部位转移切除术。首次转移切除术的中位生存期和 5 年生存率分别为 2.5 年和 41%。无病间隔时间（DFI）<12 个月的患者中位生存期为 1.7 年，而 DFI>12 个月的患者中位生存期为 6.6 年（P=0.015）。右侧与左侧原发性肿瘤的中位生存期分别为 1.9 年和 3.8 年（P=0.03）。右侧原发性肿瘤肝转移更为常见（67% vs. 41%，P=0.05）。化疗对生存没有影响。