Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/National Center for Cardiovascular Disease, Beijing, China.
Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Front Endocrinol (Lausanne). 2023 Mar 9;14:1087506. doi: 10.3389/fendo.2023.1087506. eCollection 2023.
Pheochromocytomas and paragangliomas (PPGLs) are neuroendocrine tumors, most of which are characterized by the release of catecholamine, and range in diameters from less than 1 cm to 10 cm or more. However, knowledge of the differences in clinical features between small and large PPGLs is insufficient.
A retrospective analysis of patients with PPGLs treated at our institution between January 2018 and June 2020 was performed. The clinical characteristics of patients were investigated, and comparisons were made between patients with large and small PPGLs. The logistic regression analysis was used to confirm the risk factors, and the receiver operating characteristic curve was used to evaluate the diagnostic performance of the variables.
Totally 263 patients were included, including 110 patients in small tumor group and 153 patients in large tumor group. There were more male patients in the large tumor group (p=0.009). More patients had hypertension (p<0.001) and diabetes (p=0.002) in the large tumor group. The 24-h urinary epinephrine (24hU-E) (p < 0.001) and 24-h urinary norepinephrine (24hU-NE) (p=0.002) concentrations were higher in the large tumor group. In terms of tumor location, adrenal-PPGLs were more frequent in the large tumor group (p<0.001). Multivariate logistic regression analysis showed that male sex [odds ratio (OR): 2.871, 95% confidence interval (CI): 1.444-5.711, p=0.003], 24hU-E concentrations (OR: 1.025, 95% CI:1.004-1.047, p=0.020), 24hU-NE concentrations (OR: 1.002, 95%CI: 1.001-1.004, p=0.045), and adrenal-PPGLs (OR: 2.510, 95% CI:1.256-5.018, p=0.009) were positive risk factors for large tumors. Taking above variables into the same model, the area under the receiver operating characteristic curve of the model for predicting the large tumor was 0.772 (95% CI: 0.706-0.834). After the short-term follow-up, there was no significant difference in tumor recurrence between the two groups (p=0.681).
Significant differences in numerous clinical characteristics exist between large and small PPGLs. The male patients were more likely to be with large tumors, and such tumors were more likely to reside on the adrenal glands. Catecholamine measurements also help predict tumor size of PPGLs. Clinical decision-making will benefit from this information.
嗜铬细胞瘤和副神经节瘤（PPGLs）是神经内分泌肿瘤，大多数表现为儿茶酚胺的释放，直径从小于 1 厘米到 10 厘米或更大不等。然而，对于大小 PPGLs 之间临床特征的差异的认识还不够充分。
对 2018 年 1 月至 2020 年 6 月在我院治疗的 PPGLs 患者进行回顾性分析。调查患者的临床特征，并比较大肿瘤组和小肿瘤组患者之间的差异。采用逻辑回归分析确认危险因素，并采用受试者工作特征曲线评估变量的诊断性能。
共纳入 263 例患者，其中小肿瘤组 110 例，大肿瘤组 153 例。大肿瘤组中男性患者更多（p=0.009）。大肿瘤组中更多的患者患有高血压（p<0.001）和糖尿病（p=0.002）。大肿瘤组的 24 小时尿肾上腺素（24hU-E）（p<0.001）和 24 小时尿去甲肾上腺素（24hU-NE）（p=0.002）浓度更高。就肿瘤位置而言，大肿瘤组中肾上腺-PPGLs 更为常见（p<0.001）。多因素逻辑回归分析显示，男性[比值比（OR）：2.871，95%置信区间（CI）：1.444-5.711，p=0.003]、24hU-E 浓度（OR：1.025，95%CI：1.004-1.047，p=0.020）、24hU-NE 浓度（OR：1.002，95%CI：1.001-1.004，p=0.045）和肾上腺-PPGLs（OR：2.510，95%CI：1.256-5.018，p=0.009）是大肿瘤的阳性危险因素。将上述变量纳入同一模型后，预测大肿瘤的模型的受试者工作特征曲线下面积为 0.772（95%CI：0.706-0.834）。短期随访后，两组肿瘤复发率无显著差异（p=0.681）。
大小 PPGLs 之间存在许多临床特征的显著差异。男性患者更有可能患有大肿瘤，且此类肿瘤更可能位于肾上腺。儿茶酚胺测量也有助于预测 PPGLs 的肿瘤大小。临床决策将受益于这些信息。
