Samsel Radosław, Nowak Karolina, Papierska Lucyna, Karpeta Edyta, Roszkowska-Purska Katarzyna, Smiertka Wacław, Ostrowski Tomasz, Chrapowicki Eryk, Grabowski Alan, Leszczyńska Dorota, Cichocki Andrzej
Department of Surgery, Clinic of Surgical Oncology and Neuroendocrine Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Department of Endocrinology, Medical Centre of Postgraduate Education, Bielański Hospital, Warsaw, Poland.
Front Oncol. 2023 Mar 27;13:1018475. doi: 10.3389/fonc.2023.1018475. eCollection 2023.
Adrenal gland is a common site of metastasis and on the other hand, metastases are the most frequent malignant adrenal tumors. The aim of this study was to estimate the risk of malignancy in suspicious adrenal mass in patients with a history of cancer.
This is a single-center retrospective analysis of patients with adrenal tumors treated previously for different types of cancers. Between 2004 and 2021 a hundred and six such patients were identified. Mean age of patients was 62.6 years (30-78), and mean time from oncologic treatment was 55.8 months (0-274). The most common primary cancer was kidney (RCC): 29 (27.4%), colon/rectum (CRC): 20 (18.9%) and lung (NSCLC): 20 (18.9%).
Of 106 patients, 12 had hormonally active (HA) (11,3%) and 94 (88,7%) non active (HNA) tumors In group of patients with HA tumours 4 had hypercortisolaemia and 8 had elevation of urinary metanephrines. In the first group of HA patients pathology confirmed preoperative diagnosis of adrenocortical cancer and no metastasis was found. In all patients from the second group pheochromocytomas were confirmed. Primary (PM) and secondary (SM) malignancies were found in 50 patients (47.2%). In hormone inactive group only SM - 46/94 (48.9%) were diagnosed. The odds that adrenal lesion was a metastasis were higher if primary cancer was RCC (OR 4.29) and NSCLC (OR 12.3). Metastases were also more likely with high native tumor density, and bigger size in CT. The cut-off values for tumor size and native density calculated from receiver operating characteristic (ROC) curves were 37mm and 24, respectively.
Risk of malignancy of adrenal mass in a patient with a history of cancer is high (47,2%), regardless of hormonal status. 47,2% risk of malignancy. In preoperative assessment type of primary cancer, adrenal tumour size and native density on CT should be taken into consideration as predictive factors of malignancy. Native density exceeding 24 HU was the strongest risk factor of adrenal malignancy (RR 3.23), followed by history of lung or renal cancer (RR 2.82) and maximum tumor diameter over 37 mm (RR 2.14).
肾上腺是常见的转移部位，另一方面，转移瘤是最常见的肾上腺恶性肿瘤。本研究的目的是评估有癌症病史患者肾上腺可疑肿块的恶性风险。
这是一项对先前因不同类型癌症接受治疗的肾上腺肿瘤患者的单中心回顾性分析。2004年至2021年间，共确定了106例此类患者。患者的平均年龄为62.6岁（30 - 78岁），距肿瘤治疗的平均时间为55.8个月（0 - 274个月）。最常见的原发癌是肾癌（RCC）：29例（27.4%），结肠/直肠癌（CRC）：20例（18.9%），肺癌（NSCLC）：20例（18.9%）。
106例患者中，12例有激素活性（HA）肿瘤（11.3%），94例（88.7%）无激素活性（HNA）肿瘤。在HA肿瘤患者组中，4例有皮质醇增多症，8例尿甲氧基肾上腺素升高。在第一组HA患者中，病理证实术前诊断为肾上腺皮质癌，未发现转移。在第二组所有患者中均确诊为嗜铬细胞瘤。50例患者（47.2%）发现原发性（PM）和继发性（SM）恶性肿瘤。在激素无活性组中，仅诊断出SM - 46/94例（48.9%）。如果原发癌是RCC（OR 4.29）和NSCLC（OR 12.3），肾上腺病变为转移瘤的几率更高。转移瘤在CT上的实性肿瘤密度高和体积大时也更常见。根据受试者工作特征（ROC）曲线计算的肿瘤大小和实性密度的临界值分别为37mm和24。
有癌症病史患者肾上腺肿块的恶性风险很高（47.2%），与激素状态无关。恶性风险为47.2%。在术前评估中，应将原发癌类型、肾上腺肿瘤大小和CT上的实性密度作为恶性肿瘤的预测因素。实性密度超过24 HU是肾上腺恶性肿瘤最强的风险因素（RR 3.23），其次是肺癌或肾癌病史（RR 2.82）和最大肿瘤直径超过37mm（RR 2.14）。
