III-IV 期肾上腺皮质癌（ACC）的预后因素：一项欧洲肾上腺肿瘤研究网络（ENSAT）的研究。
Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study.
机构信息
French Adrenal Cancer Network, Institut National du Cancer, Paris.
Department of Biostatistics and Epidemiology, Gustave Roussy and University Paris-Sud, Villejuif, France.
出版信息
Ann Oncol. 2015 Oct;26(10):2119-25. doi: 10.1093/annonc/mdv329.
BACKGROUND
The clinical course of advanced adrenocortical carcinoma (ACC) is heterogeneous. Our study aimed primarily to refine and make headway in the prognostic stratification of advanced ACC.
PATIENTS AND METHODS
Patients with advanced ENSAT ACC (stage III or stage IV) at diagnosis registered between 2000 and 2009 in the ENSAT database were enrolled. The primary end point was overall survival (OS). Parameters of potential prognostic relevance were selected. Univariate and multivariate analyses were carried out: model 1 'before surgery'; model 2 'post-surgery'.
RESULTS
Four hundred and forty-four patients with advanced ENSAT ACC (stage III: 210; stage IV: 234) were analyzed. After a median follow-up of 55.2 months, the median OS was 24 months. A modified ENSAT (mENSAT) classification was validated: stage III (invasion of surrounding tissues/organs or the vena renalis/cava) and stage IVa, IVb, IVc (2, 3 or >3 metastatic organs, including N, respectively). Two- or 5-year OS was 73%, 46%, 26% and 15% or 50%, 15%, 14% and 2% for stages III, IVa, IVb and IVc, respectively. In the multivariate analysis, mENSAT stages (stages IVa, IVb, or IVc, respectively) were significantly correlated with OS (P < 0.0001), as well as additional parameters: age ≥ 50 years (P < 0.0001), tumor- or hormone-related symptoms (P = 0.01 and 0.03, respectively) in model 1 but also the R status (P = 0.001) and Grade (Weiss >6 and/or Ki67 ≥ 20%, P = 0.06) in model 2.
CONCLUSION
The mENSAT classification and GRAS parameters (Grade, R status, Age and Symptoms) were found to best stratify the prognosis of patients with advanced ACC.
背景
晚期肾上腺皮质癌（ACC）的临床病程具有异质性。我们的研究旨在对晚期 ACC 的预后分层进行精细化处理并取得进展。
患者和方法
本研究纳入了 2000 年至 2009 年期间登记在 ENSAT 数据库中的诊断为晚期 ENSAT ACC（III 期或 IV 期）的患者。主要终点为总生存期（OS）。选择了有潜在预后相关性的参数。进行了单因素和多因素分析：模型 1“术前”；模型 2“术后”。
结果
共分析了 444 例晚期 ENSAT ACC（III 期：210 例；IV 期：234 例）患者。中位随访 55.2 个月后，中位 OS 为 24 个月。验证了改良 ENSAT（mENSAT）分类：III 期（侵犯周围组织/器官或肾静脉/腔静脉）和 IVa、IVb、IVc 期（分别为 2、3 或>3 个转移器官，包括 N）。III、IVa、IVb 和 IVc 期的 2 年和 5 年 OS 分别为 73%、46%、26%和 15%或 50%、15%、14%和 2%。多因素分析中，mENSAT 分期（分别为 IVa、IVb 或 IVc 期）与 OS 显著相关（P<0.0001），此外还与其他参数相关：年龄≥50 岁（P<0.0001）、肿瘤或激素相关症状（P=0.01 和 0.03）在模型 1 中，而 R 状态（P=0.001）和分级（Weiss>6 且/或 Ki67≥20%，P=0.06）在模型 2 中。
结论
mENSAT 分类和 GRAS 参数（分级、R 状态、年龄和症状）可最佳分层晚期 ACC 患者的预后。
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