Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, 320W 10th Ave, Columbus, OH, 43210, USA.
Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, 1800 Cannon Drive, Columbus, OH, 43210, USA.
Horm Cancer. 2019 Dec;10(4-6):161-167. doi: 10.1007/s12672-019-00367-0. Epub 2019 Aug 29.
Adrenocortical carcinoma (ACC) is a rare malignancy with limited data to guide the management of metastatic disease. The optimal treatment strategies and outcomes of patients with metastatic ACC remain areas of active interest. We retrospectively reviewed patients with ACC who were treated with systemic therapy between January 1997 and October 2016 at The Ohio State University Comprehensive Cancer Center. Kaplan-Meier and Cox proportional hazards regression models were used for survival analysis. We identified 65 patients diagnosed with ACC during the given time period, and 36 patients received systemic therapy for distant metastatic disease. Median age at diagnosis was 50 (range 28-87). Median overall survival (OS) from time of diagnosis of ACC was 27 months (95% CI 19.6-39.3), and median OS from time of systemic treatment for metastatic disease was 18.7 months (95% CI 9.3-26.0). Clinical characteristics at time of initiation of systemic therapy were assessed, and presence of bone metastases (p = 0.66), ascites (p = 0.19), lung metastases (p = 0.12), liver metastases (p = 0.47), as well as hormonal activity of tumor (p = 0.19), were not prognostic for survival. Six patients with liver metastases treated with systemic therapy who received liver-directed therapy with either transarterial chemoembolization (TACE) or selective internal radiation therapy (SIRT) had longer survival than those who did not (p = 0.011). Our data expands the knowledge of clinical characteristics and outcomes of patients with ACC and suggests a possible role for incorporating liver-directed therapies for patients with hepatic metastases.
肾上腺皮质癌（ACC）是一种罕见的恶性肿瘤，其转移性疾病的管理数据有限。转移性 ACC 患者的最佳治疗策略和结果仍然是人们关注的热点。我们回顾性分析了 1997 年 1 月至 2016 年 10 月期间在俄亥俄州立大学综合癌症中心接受系统治疗的 ACC 患者。采用 Kaplan-Meier 和 Cox 比例风险回归模型进行生存分析。我们确定了在给定时间段内诊断为 ACC 的 65 例患者，其中 36 例患者接受了远处转移性疾病的系统治疗。诊断时的中位年龄为 50 岁（范围 28-87 岁）。从 ACC 诊断时的中位总生存期（OS）为 27 个月（95%CI 19.6-39.3），从转移性疾病开始系统治疗时的中位 OS 为 18.7 个月（95%CI 9.3-26.0）。评估了开始系统治疗时的临床特征，骨转移（p = 0.66）、腹水（p = 0.19）、肺转移（p = 0.12）、肝转移（p = 0.47）以及肿瘤的激素活性（p = 0.19）均与生存无关。6 例接受系统治疗且有肝转移的患者接受了经动脉化疗栓塞（TACE）或选择性内放射治疗（SIRT）的肝定向治疗，其生存时间长于未接受肝定向治疗的患者（p = 0.011）。我们的数据扩展了 ACC 患者的临床特征和结局的知识，并表明对于有肝转移的患者，肝定向治疗可能具有一定作用。
