Press Danielle, Akyuz Muhammet, Dural Cem, Aliyev Shamil, Monteiro Rosebel, Mino Jeff, Mitchell Jamie, Hamrahian Amir, Siperstein Allan, Berber Eren
Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
Surgery. 2014 Dec;156(6):1523-7; discussion 1527-8. doi: 10.1016/j.surg.2014.08.044. Epub 2014 Nov 11.
The recurrence rate of pheochromocytoma after adrenalectomy is 6.5-16.5%. This study aims to identify predictors of recurrence and optimal biochemical testing and imaging for detecting the recurrence of pheochromocytoma.
In this retrospective study we reviewed all patients who underwent adrenalectomy for pheochromocytoma during a 14-year period at a single institution.
One hundred thirty-five patients had adrenalectomy for pheochromocytoma. Eight patients (6%) developed recurrent disease. The median time from initial operation to diagnosis of recurrence was 35 months. On multivariate analysis, tumor size >5 cm was an independent predictor of recurrence. One patient with recurrence died, 4 had stable disease, 2 had progression of disease, and 1 was cured. Recurrence was diagnosed by increases in plasma and/or urinary metanephrines and positive imaging in 6 patients (75%), and by positive imaging and normal biochemical levels in 2 patients (25%).
Patients with large tumors (>5 cm) should be followed vigilantly for recurrence. Because 25% of patients with recurrence had normal biochemical levels, we recommend routine imaging and testing of plasma or urinary metanephrines for prompt diagnosis of recurrence.
肾上腺切除术后嗜铬细胞瘤的复发率为6.5 - 16.5%。本研究旨在确定复发的预测因素以及检测嗜铬细胞瘤复发的最佳生化检测和影像学检查方法。
在这项回顾性研究中，我们回顾了在单一机构14年间因嗜铬细胞瘤接受肾上腺切除术的所有患者。
135例患者因嗜铬细胞瘤接受了肾上腺切除术。8例（6%）出现疾病复发。从初次手术到复发诊断的中位时间为35个月。多因素分析显示，肿瘤大小>5 cm是复发的独立预测因素。1例复发患者死亡，4例病情稳定，2例病情进展，1例治愈。6例（75%）患者通过血浆和/或尿间甲肾上腺素升高及影像学检查阳性诊断为复发，2例（25%）患者通过影像学检查阳性及生化指标正常诊断为复发。
对于肿瘤较大（>5 cm）的患者应密切随访有无复发。由于25%的复发患者生化指标正常，我们建议常规进行影像学检查及血浆或尿间甲肾上腺素检测以早期诊断复发。
