Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Surgical Outcomes Program, Robert D and Patricia E Kern Center for The Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
World J Surg. 2021 Jan;45(1):188-194. doi: 10.1007/s00268-020-05801-x. Epub 2020 Oct 9.
The role of lymphadenectomy in adrenocortical carcinoma resection is controversial. Therefore, we conducted a population-based study to assess the association between positive lymph nodes (LN) and survival.
The Surveillance, Epidemiology, and End Results set of cancer registries were utilized. The associations between positive lymph nodes and tumor size, grade and laterality were assessed. Cancer specific survival (CSS) trends and factors affecting survival were analyzed.
A total of 2170 adult patients were identified; 60% underwent resection. Among those resected, LN were examined in 23% and were positive in 25% of patients with LN examined. Patients with positive LN tended to have smaller tumors compared to those with negative LN (12 ± 5 vs 15 ± 11 cm, p = 0.02). The rate of positive LN was higher in right ACC, p = 0.03. Median overall CSS was 21 months, with significant differences between resection (42 months) and no resection (4 months), p < 0.01. Median CSS did not change over time when comparing ACC patients who underwent surgery before 2000, 2000-2009, and 2010-2016. On multivariable analysis including resection group, advanced age, grades III and IV, regional and distant stage, in addition to positive LN were associated with worse survival, p < 0.05.
Lymphadenectomy is infrequently performed during ACC resection, and when performed, regional LN involvement tends to be associated with worse survival. Neoplasm size and grade were not associated with LN involvement and therefore, do not inform lymphadenectomy need. Further studies are needed to assess the indications for, and value of lymphadenectomy in ACC.
在肾上腺皮质癌切除术中，淋巴结清扫的作用存在争议。因此，我们进行了一项基于人群的研究，以评估阳性淋巴结（LN）与生存之间的关系。
利用监测、流行病学和最终结果癌症登记数据库。评估了阳性淋巴结与肿瘤大小、分级和侧别之间的关系。分析了癌症特异性生存（CSS）趋势和影响生存的因素。
共确定了 2170 名成年患者；60%接受了切除术。在接受手术的患者中，23%进行了淋巴结检查，其中 25%的患者淋巴结检查阳性。与阴性淋巴结相比，阳性淋巴结的患者肿瘤往往较小（12 ± 5 与 15 ± 11cm，p = 0.02）。右侧 ACC 的阳性淋巴结率较高，p = 0.03。总中位 CSS 为 21 个月，与未行切除术（4 个月）相比，行切除术（42 个月）的患者 CSS 差异有统计学意义（p<0.01）。当比较 2000 年前、2000-2009 年和 2010-2016 年接受手术的 ACC 患者时，CSS 中位数并未随时间变化。在包括手术组、年龄较大、分级 III 和 IV、局部和远处分期以及阳性 LN 在内的多变量分析中，与较差的生存相关（p<0.05）。
在 ACC 切除术中，淋巴结清扫术很少进行，而当进行时，区域淋巴结受累往往与较差的生存相关。肿瘤大小和分级与淋巴结受累无关，因此不能提示需要进行淋巴结清扫术。需要进一步研究以评估 ACC 淋巴结清扫术的适应证和价值。
