Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa036.
Adrenocortical carcinomas (ACCs) carry a poor prognosis. This study assessed the comparative performance of existing nomograms in estimating the likelihood of survival, along with the value of conditional survival estimation for patients who had already survived for a given length of time after surgery.
This was an observational study based on a prospectively developed departmental database that recorded details of patients operated for ACC in a UK tertiary referral centre.
Of 74 patients with ACC managed between 2001 and 2020, data were analysed for 62 patients (32 women and 30 men, mean(s.d.) age 51(17) years) who had primary surgical treatment in this unit. Laparoscopic (9) or open adrenalectomies (53) were performed alone or in association with a multivisceral resection (27). Most of the tumours were left-sided (40) and 18 were cortisol-secreting.Overall median survival was 33 months, with 1-, 3- and 5-year survival rates of 79, 49, and 41 per cent respectively. Age over 55 years, higher European Network for Study of Adrenal Tumours stage, and cortisol secretion were associated with poorer survival in univariable analyses. Four published nomograms suggested widely variable outcomes that did not correlate with observed overall survival at 1, 3 or 5 years after operation. The 3-year conditional survival at 2 years (probability of surviving to postoperative year 5) was 65 per cent, compared with a 5-year actuarial survival rate of 41 per cent calculated from the time of surgery.
Survival of patients with ACC correlates with clinical parameters but not with published nomograms. Conditional survival might provide a more accurate estimate of survival for patients who have already survived for a certain amount of time after resection.
肾上腺皮质癌（ACC）预后不良。本研究评估了现有的列线图在估计生存可能性方面的表现，并评估了对已经接受手术治疗后给定时间的患者进行条件生存估计的价值。
这是一项基于前瞻性开发的部门数据库的观察性研究，该数据库记录了在英国三级转诊中心接受 ACC 手术治疗的患者的详细信息。
在 2001 年至 2020 年间管理的 74 例 ACC 患者中，对 62 例（32 名女性和 30 名男性，平均年龄为 51(17)岁）在本单位接受原发性手术治疗的数据进行了分析。单独或与多脏器切除术（27 例）联合进行腹腔镜（9 例）或开放肾上腺切除术（53 例）。大多数肿瘤位于左侧（40 例），18 例为皮质醇分泌。总中位生存时间为 33 个月，1、3 和 5 年生存率分别为 79%、49%和 41%。单变量分析显示，年龄超过 55 岁、欧洲肾上腺肿瘤研究网络分期较高和皮质醇分泌与生存较差相关。四个已发表的列线图提示结果差异很大，与手术后 1、3 或 5 年的总生存观察结果不相关。手术后 2 年（术后第 5 年生存的概率）的 3 年条件生存率为 65%，而从手术时间计算的 5 年实际生存率为 41%。
ACC 患者的生存与临床参数相关，但与已发表的列线图不相关。条件生存可能为已经接受一定时间手术后的患者提供更准确的生存估计。
