Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA.
Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy-Hospital Brabois Adultes, University de Lorraine, Nancy, France.
Ann Surg Oncol. 2017 Nov;24(12):3617-3623. doi: 10.1245/s10434-017-6064-3. Epub 2017 Sep 11.
The role of lymphadenectomy in adrenocortical carcinoma (ACC) is controversial, and formal lymph node (LN) dissection is not routine. We sought to determine the minimum number of LNs that must be examined to accurately identify a patient as node negative.
The National Cancer Database was used to identify patients diagnosed with ACC from 2004 to 2013 who underwent surgical resection. Patients with distant metastases, multivisceral resection, or missing surgical or lymphadenectomy data were excluded. The primary outcome was overall survival (OS).
LNs were identified on histopathology in 156 patients. Of these, 35 (22%) had at least one positive LN. Positive LNs were associated with positive surgical margins (odds ratio [OR] 5.80, p = 0.002) and increasing LN yield (OR 1.06, p = 0.02). Overall, on Cox regression analysis, LN positivity (hazard ratio [HR] 3.02, p < 0.001) and positive surgical margins (HR 2.06, p = 0.048) independently predicted poor OS after controlling for other factors that may influence survival. LN(-) disease in patients with one to three LNs examined had poorer overall survival compared with when at least four LNs were examined (p = 0.02). None of the other patient, tumor, and treatment variables had any impact on OS of the LN(-) cohort. The likelihood of identifying nodal involvement was higher on examination of at least four LNs compared with examination of one to three LNs (30 vs. 16%, p = 0.03).
LN positivity in ACC tumors independently predicts worse 5-year OS and a minimum of four LNs may be required to accurately determine LN negativity.
淋巴结切除术在肾上腺皮质癌（ACC）中的作用存在争议，且规范的淋巴结（LN）清扫术并不常规进行。我们旨在确定必须检查的最小 LN 数量，以准确地确定患者为淋巴结阴性。
本研究使用国家癌症数据库，从 2004 年至 2013 年期间，识别接受手术切除的 ACC 患者。排除远处转移、多脏器切除或手术或淋巴结切除术数据缺失的患者。主要结局为总生存（OS）。
在 156 例患者的组织病理学中发现了 LN。其中，35 例（22%）至少有一个阳性 LN。阳性 LN 与阳性手术切缘（比值比 [OR] 5.80，p = 0.002）和 LN 检出量增加（OR 1.06，p = 0.02）相关。总体而言，在 Cox 回归分析中，LN 阳性（风险比 [HR] 3.02，p < 0.001）和阳性手术切缘（HR 2.06，p = 0.048）在控制其他可能影响生存的因素后，独立预测 OS 不良。在检查 1 至 3 个 LN 的患者中，LN（-）疾病的总体生存率低于检查至少 4 个 LN 的患者（p = 0.02）。其他患者、肿瘤和治疗变量均未对 LN（-）队列的 OS 产生任何影响。与检查 1 至 3 个 LN 相比，检查至少 4 个 LN 时，识别淋巴结受累的可能性更高（30%比 16%，p = 0.03）。
ACC 肿瘤的 LN 阳性独立预测 5 年 OS 更差，可能需要至少 4 个 LN 才能准确确定 LN 阴性。
