Mege Diane, Taieb David, Lowery Aoife, Loundou Anderson, DE Micco Catherine, Castinetti Frederic, Morange Isabelle, Henry Jean-François, Sebag Frederic
Department of Endocrine Surgery, Aix-Marseille University and Timone Hospital, Marseille, France.
Anticancer Res. 2014 May;34(5):2581-8.
Large adrenal tumors (LATs, ≥6 cm) are uncommon and associated with malignancy in 25% of cases. Their surgical management remains debatable. The aim of the present report was to evaluate the current incidence, nature and management of LAT.
We carried out a retrospective review of LATs managed in a tertiary referral center (2002-2011).
Eighty-one patients were included (out of a total of 750 with adrenal tumors, 11%). Nine patients had no surgical intervention (11%). Fifty-two LATs were malignant (64%): adrenocortical carcinoma (44%), metastasis (27%) and pheochromocytoma (21%). Patients with malignant tumors exhibited a poorer 5-year overall survival than those with benign tumors (53.4% versus 96.3%, p=0.001). Disease-related mortality was approximately 60%, 29% and 0% for those with metastasis, adrenal carcinoma and malignant pheochromocytoma, respectively. The recurrence rate was the same for the three malignant sub-groups (30%).
LATs are rare and more frequently malignant than previously reported. Some are benign and do not require for surgical intervention. Surgical indication and approach should be tailored for each patient.
大肾上腺肿瘤（LATs，≥6 cm）并不常见，25%的病例与恶性肿瘤相关。其手术治疗仍存在争议。本报告的目的是评估LATs的当前发病率、性质及治疗方法。
我们对一家三级转诊中心（2002 - 2011年）治疗的LATs进行了回顾性研究。
共纳入81例患者（占肾上腺肿瘤患者总数750例的11%）。9例患者未接受手术治疗（11%）。52例LATs为恶性（64%）：肾上腺皮质癌（44%）、转移瘤（27%）和嗜铬细胞瘤（21%）。恶性肿瘤患者的5年总生存率低于良性肿瘤患者（53.4%对96.3%，p = 0.001）。转移瘤、肾上腺皮质癌和恶性嗜铬细胞瘤患者的疾病相关死亡率分别约为60%、29%和0%。三个恶性亚组的复发率相同（30%）。
LATs罕见，且比之前报道的更易发生恶变。部分为良性，无需手术干预。手术指征和方法应根据每位患者的情况量身定制。
