Department of Endocrine Neoplasia and Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
J Clin Endocrinol Metab. 2013 Jan;98(1):192-7. doi: 10.1210/jc.2012-2367. Epub 2012 Nov 12.
Adrenocortical carcinoma (ACC) is a rare malignancy with high recurrence and mortality rates. The role of adjuvant radiation therapy (RT) to improve outcome remains unclear.
The aim of this study was to evaluate the impact of adjuvant RT on overall survival and recurrence rates of ACC patients.
We conducted a retrospective cohort study of select ACC patients who were seen at The University of Texas MD Anderson Cancer Center (MDACC) between 1998 and 2011. All patients in this study underwent primary tumor resection and received adjuvant RT within 3 months of primary surgical resection prior to referral to the MDACC. We compared patients who had surgery and adjuvant RT with patients who had surgery alone.
Baseline characteristics and adjuvant mitotane use were not significantly different between the adjuvant RT group (n = 16) and the non-RT group (n = 32). Local recurrence occurred in seven patients (43.8%) who received RT and 10 patients (31.3%) in the control group. At 5 yr, the estimated local recurrence-free rate (95% confidence interval) was 53% (32-87%) in the RT group and 67% (52-86%) in the non-RT group (P = 0.53). The distributions of time to distant recurrence and recurrence-free survival were not significantly different between the two groups. Using a multivariate Cox proportional hazards model for overall survival, the hazard ratio for RT use was 1.593 (95% confidence interval, 0.707-3.589; P = 0.26) after adjusting for stage and adjuvant mitotane therapy.
ACC has high rates of recurrence. In our study, RT did not improve clinical outcomes in patients who received their initial care in the community. We believe there is a need for a collaborative, multicenter, prospective randomized trial to evaluate the role of adjuvant treatments (both mitotane and RT) to assess their impact on recurrence patterns and survival.
肾上腺皮质癌（ACC）是一种罕见的恶性肿瘤，其复发率和死亡率均较高。辅助放疗（RT）改善预后的作用尚不清楚。
本研究旨在评估辅助 RT 对 ACC 患者总生存率和复发率的影响。
我们对 1998 年至 2011 年期间在德克萨斯大学 MD 安德森癌症中心（MDACC）就诊的 ACC 患者进行了一项选择回顾性队列研究。本研究中的所有患者均接受了原发肿瘤切除术，并在转诊至 MDACC 之前的 3 个月内接受了辅助 RT。我们比较了接受手术和辅助 RT 的患者与仅接受手术的患者。
辅助 RT 组（n=16）和非 RT 组（n=32）的基线特征和辅助米托坦的使用无显著差异。接受 RT 的 7 例患者（43.8%）和对照组的 10 例患者（31.3%）发生局部复发。在 5 年时，RT 组的局部无复发生存率（95%置信区间）估计为 53%（32%-87%），而非 RT 组为 67%（52%-86%）（P=0.53）。两组之间远处复发时间和无复发生存率的分布无显著差异。使用多变量 Cox 比例风险模型进行总体生存分析，在校正分期和辅助米托坦治疗后，RT 使用的风险比为 1.593（95%置信区间，0.707-3.589；P=0.26）。
ACC 复发率较高。在我们的研究中，在社区接受初始治疗的患者中，RT 并未改善临床结局。我们认为需要进行一项协作、多中心、前瞻性随机试验，以评估辅助治疗（米托坦和 RT）的作用，评估其对复发模式和生存的影响。
