Lo Winifred M, Kariya Christine M, Hernandez Jonathan M
Am Surg. 2019 Jan 1;85(1):23-28.
Metastatic adrenocortical carcinoma (ACC) is associated with a poor 5-year survival rate and high rate of recurrence. Outcomes after resection for patients with limited disease remain poorly described. We conducted a PubMed search for articles published between 1950 and 2017 using the terms "ACC," "recurrence," and "surgery." Patients with metastatic ACC at any anatomic site who had undergone surgical resection were included. Thirteen studies met the criteria. Patients were grouped according to the recurrence site. Pulmonary metastasectomy was reported in 50 patients with moderate complications and without perioperative mortality. Disease recurrence rates range from 25 to 42 per cent, with median overall survival of 40 to 50 months. Hepatic metastasectomy was reported in 108 patients with a single perioperative mortality. Disease recurrence rates range from 65 to 100 per cent, with median disease-free survival (DFS) and OS of five to nine months and 22 to 76 months. Peritoneal cytoreduction and heated intraperitoneal chemotherapy have been reported for 10 patients with minimal morbidity and without perioperative mortality. The disease recurrence rate was 70 per cent, with DFS of 19 months. For selected patients with recurrent ACC in the lungs, liver, or peritoneum, metastasectomy is safe and can be associated with prolonged survival. However, subsequent disease recurrence is common, and patients should be counseled accordingly.
转移性肾上腺皮质癌（ACC）的5年生存率较低且复发率高。对于疾病局限的患者，切除术后的预后情况仍鲜有描述。我们在PubMed上检索了1950年至2017年间发表的文章，检索词为“ACC”“复发”和“手术”。纳入了在任何解剖部位发生转移性ACC且接受过手术切除的患者。有13项研究符合标准。患者根据复发部位分组。50例患者接受了肺转移瘤切除术，并发症中等，无围手术期死亡。疾病复发率为25%至42%，总生存期中位数为40至50个月。108例患者接受了肝转移瘤切除术，有1例围手术期死亡。疾病复发率为65%至100%，无病生存（DFS）和总生存期（OS）中位数分别为5至9个月和22至76个月。10例患者接受了腹膜减瘤术和热灌注化疗，发病率极低，无围手术期死亡。疾病复发率为70%，DFS为19个月。对于部分肺部、肝脏或腹膜复发ACC的患者，转移瘤切除术是安全的，且可能延长生存期。然而，后续疾病复发很常见，应据此对患者进行咨询。
