Amini Neda, Margonis Georgios Antonios, Kim Yuhree, Tran Thuy B, Postlewait Lauren M, Maithel Shishir K, Wang Tracy S, Evans Douglas B, Hatzaras Ioannis, Shenoy Rivfka, Phay John E, Keplinger Kara, Fields Ryan C, Jin Linda X, Weber Sharon M, Salem Ahmed, Sicklick Jason K, Gad Shady, Yopp Adam C, Mansour John C, Duh Quan-Yang, Seiser Natalie, Solorzano Carmen C, Kiernan Colleen M, Votanopoulos Konstantinos I, Levine Edward A, Poultsides George A, Pawlik Timothy M
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Ann Surg Oncol. 2016 Jan;23(1):126-33. doi: 10.1245/s10434-015-4810-y. Epub 2015 Aug 18.
Adrenocortical carcinoma (ACC) is a rare malignancy. The aim of this study was to determine the incidence and patterns of recurrence after curative-intent surgery for ACC.
Patients who underwent curative-intent resection for ACC between 1993 and 2014 were identified from 13 academic institutions participating in the United States ACC study group. Patients with metastasis or an R2 margin were excluded. Patterns and rates of recurrence were determined and classified as locoregional and distant recurrence.
A total of 180 patients with a median age of 52 years (interquartile range 43-61) were identified. Most patients underwent open surgery (n = 111, 64.5 %) and had an R0 resection margin (n = 117, 75.0 %). At last follow-up, 116 patients (64.4 %) had experienced recurrence (locoregional only, n = 41, 36.3 %; distant only, n = 51, 45.1 %; locoregional and distant, n = 21, 18.6 %). Median time to recurrence was 18.8 months. Several factors were associated with locoregional recurrence, including left-sided ACC location (odds ratio [OR] 2.71, 95 % confidence interval [CI] 1.06-6.89) and T3/T4 disease (reference T1/T2, OR 3.04, 95 % CI 1.19-7.80) (both p < 0.05). Distant recurrence was associated with larger tumor size (OR 1.11, 95 % CI 1.01-1.24) and T3/T4 disease (reference T1/T2, OR 5.23, 95 % CI 1.70-16.10) (both p < 0.05). Patients with combined locoregional and distant recurrence had worse survival (3- and 5-year survival: 39.5, 19.7 %) versus patients with distant-only (3- and 5-year survival 55.1, 43.3 %) or locoregional-only recurrence (3- and 5-year survival 81.4, 64.1 %) (p = 0.01).
Nearly two-thirds of patients experienced disease recurrence after resection of ACC. Although a subset of patients experienced recurrence with locoregional disease only, many patients experienced recurrence with distant disease as a component of recurrence and had a poor prognosis.
肾上腺皮质癌（ACC）是一种罕见的恶性肿瘤。本研究的目的是确定ACC根治性手术后的复发率和复发模式。
从参与美国ACC研究组的13家学术机构中，识别出1993年至2014年间接受ACC根治性切除术的患者。排除有转移或R2切缘的患者。确定复发模式和复发率，并分为局部区域复发和远处复发。
共识别出180例患者，中位年龄52岁（四分位间距43 - 61岁）。大多数患者接受了开放手术（n = 111，64.5%），且切缘为R0（n = 117，75.0%）。在最后一次随访时，116例患者（64.4%）出现复发（仅局部区域复发，n = 41，36.3%；仅远处复发，n = 51，45.1%；局部区域和远处复发，n = 21，18.6%）。复发的中位时间为18.8个月。几个因素与局部区域复发相关，包括左侧ACC位置（比值比[OR] 2.71，95%置信区间[CI] 1.06 - 6.89）和T3/T4期疾病（参照T1/T2期，OR 3.04，95% CI 1.19 - 7.80）（均p < 0.05）。远处复发与肿瘤较大（OR 1.11，95% CI 1.01 - 1.24）和T3/T4期疾病（参照T1/T2期，OR 5.23，95% CI 1.70 - 16.10）相关（均p < 0.05）。局部区域和远处联合复发的患者生存率较差（3年和5年生存率：39.5%，19.7%），而仅远处复发（3年和5年生存率55.1%，43.3%）或仅局部区域复发（3年和5年生存率81.4%，64.1%）的患者（p = 0.01）。
近三分之二的患者在ACC切除术后出现疾病复发。虽然一部分患者仅出现局部区域疾病复发，但许多患者复发时伴有远处疾病，预后较差。
