Department of Internal Medicine, Máxima Medical Center, Ds. Theodor Fliednerstraat 1, 5631 BM Eindhoven, Veldhoven, The Netherlands.
Eur J Endocrinol. 2013 Jun 7;169(1):83-9. doi: 10.1530/EJE-13-0142. Print 2013 Jul.
Adrenocortical carcinoma (ACC) is a rare disease with an estimated incidence of one to two cases per 1 million inhabitants. The Dutch Adrenal Network (DAN) was initiated with the aim to improve patient care and to stimulate scientific research on ACC. Currently, not all patients with ACC are treated in specialized DAN hospitals. The objective of the current investigation was to determine whether there are differences in survival between patients operated on in DAN hospitals and those operated on in non-DAN hospitals.
The study was set up as a retrospective and population-based survival analysis.
Data on all adult ACC patients diagnosed between 1999 and 2009 were obtained from The Netherlands Cancer Registry (NCR). Overall survival was calculated and a comparison was made between DAN and non-DAN hospitals.
The NCR contained data of 189 patients. The median survival of patients with European Network for the Study of Adrenal Tumors stages I-III disease was significantly longer for patients operated on in a DAN hospital (n=46) than for those operated on in a non-DAN hospital (n=37, 5-year survival 63 vs 42%). Survival remained significantly different after correction for sex, age, year of diagnosis, and stage of disease in the multivariate analysis (hazard ratio 1.96 (95% CI 1.01-3.81), P=0.047).
The results associate surgery in a DAN center with a survival benefit for patients with local or locally advanced ACC. We hypothesize that a multidisciplinary approach for these patients explains the observed survival benefit. These findings should be carefully considered in view of the aim for further centralization of ACC treatment.
肾上腺皮质癌（ACC）是一种罕见疾病，估计每 100 万居民中有 1 至 2 例。荷兰肾上腺网络（DAN）的成立旨在改善患者的治疗效果，并促进 ACC 的科学研究。目前，并非所有 ACC 患者都在专门的 DAN 医院接受治疗。本研究旨在确定在 DAN 医院和非 DAN 医院接受手术的患者的生存是否存在差异。
本研究为回顾性和基于人群的生存分析。
从荷兰癌症登记处（NCR）获取了 1999 年至 2009 年间诊断的所有成人 ACC 患者的数据。计算了总生存率，并对 DAN 和非 DAN 医院进行了比较。
NCR 包含了 189 名患者的数据。欧洲肾上腺肿瘤研究网络（ENETS）I-III 期疾病患者在 DAN 医院（n=46）接受手术的中位生存期明显长于在非 DAN 医院（n=37）接受手术的患者（5 年生存率为 63%比 42%）。在校正了性别、年龄、诊断年份和疾病分期后，多变量分析结果仍然显示生存差异有统计学意义（危险比 1.96（95%置信区间 1.01-3.81），P=0.047）。
研究结果表明，在 DAN 中心进行手术可为局部或局部进展性 ACC 患者带来生存获益。我们假设，对这些患者采用多学科方法解释了观察到的生存获益。在考虑进一步集中 ACC 治疗的目标时，应仔细考虑这些发现。
