激素分泌对肾上腺皮质癌患者生存的影响：一项多中心研究。
The effect of hormonal secretion on survival in adrenocortical carcinoma: A multi-center study.
作者信息
Sada Alaa, Foster Trenton R, Al-Ward Ruaa, Sawani Sahar, Charchar HElaine, Pishdad Reza, Ben-Shlomo Anat, Dy Benzon M, Lyden Melanie L, Bergsland Emily, Jasim Sina, Raj Nitya, Shank Jessica B, Hamidi Oksana, Hamrahian Amir H, Chambô José L, Srougi Victor, Fragoso Maria Cbv, Graham Paul H, Habra Mouhammed Amir, Bancos Irina, McKenzie Travis J
机构信息
Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: https://twitter.com/Aabdusada.
Department of Surgery, Mayo Clinic, Rochester, MN.
出版信息
Surgery. 2024 Jan;175(1):80-89. doi: 10.1016/j.surg.2023.04.070. Epub 2023 Nov 8.
BACKGROUND
Current evidence suggests that cortisol secreting adrenocortical carcinoma has worse prognosis compared to non-secreting adrenocortical carcinoma. However, the effect of other secretory subtypes is unknown.
METHODS
This multicenter study within the American-Australian-Asian Adrenal Alliance included adults with adrenocortical carcinoma (1997-2020). We compared overall survival and disease-free survival among cortisol secreting, mixed cortisol/androgen secreting, androgen secreting, and non-secreting adrenocortical carcinoma.
RESULTS
Of the 807 patients (mean age 50), 719 included in the secretory subtype analysis: 24.5% were cortisol secreting, 13% androgen secreting, 28% mixed cortisol/androgen, 32.5% non-secreting, and 2% were mineralocorticoid secreting. Median overall survival and disease-free survival for the entire cohort were 60 and 9 months, respectively. Median overall survival was 36 months for cortisol, 30 for mixed, 60 for androgen secreting, and 115 for non-secreting adrenocortical carcinoma, P < .01. Median disease-free survival was 7 months for cortisol, 8 for mixed, 10 for androgen, and 12 for non-secreting adrenocortical carcinoma, P = .06. On multivariable analysis of age, sex, Ki67%, secretory subtype, stage, resection, and adjuvant therapy, predictors of worse overall survival were older age, higher Ki67%, stage IV, mixed secreting, R1, and no adjuvant therapy, P < .05. On subgroup analysis of R0 resection, predictors of worse overall survival included older age and higher Ki67%. Ki67% ≥40, stage III and cortisol secretion were associated with worse disease-free survival.
CONCLUSION
Mixed cortisol/androgen secreting adrenocortical carcinoma was associated with worse overall survival, while cortisol or androgen secreting alone were not. Notably, among patients after R0 resection, secretory subtype did not affect overall survival. Cortisol secreting adrenocortical carcinoma demonstrated worse disease-free survival. Ki67% remained a strong predictor of worse overall survival and disease-free survival independent of stage.
背景
目前的证据表明，分泌皮质醇的肾上腺皮质癌与不分泌皮质醇的肾上腺皮质癌相比，预后更差。然而，其他分泌亚型的影响尚不清楚。
方法
这项在美国-澳大利亚-亚洲肾上腺联盟内开展的多中心研究纳入了患有肾上腺皮质癌的成年人（1997 - 2020年）。我们比较了分泌皮质醇、混合分泌皮质醇/雄激素、分泌雄激素和不分泌皮质醇的肾上腺皮质癌患者的总生存期和无病生存期。
结果
在807例患者（平均年龄50岁）中，719例纳入分泌亚型分析：24.5%分泌皮质醇，13%分泌雄激素，28%混合分泌皮质醇/雄激素，32.5%不分泌，2%分泌盐皮质激素。整个队列的中位总生存期和无病生存期分别为60个月和9个月。分泌皮质醇的患者中位总生存期为36个月，混合分泌的为30个月，分泌雄激素的为60个月，不分泌皮质醇的肾上腺皮质癌为115个月，P < 0.01。分泌皮质醇的患者中位无病生存期为7个月，混合分泌的为8个月，分泌雄激素的为10个月，不分泌皮质醇的肾上腺皮质癌为12个月，P = 0.06。在对年龄、性别、Ki67%、分泌亚型、分期、切除情况和辅助治疗进行多变量分析时，总生存期较差的预测因素为年龄较大、Ki67%较高、IV期、混合分泌、R1切除且未接受辅助治疗，P < 0.05。在R0切除的亚组分析中，总生存期较差的预测因素包括年龄较大和Ki67%较高。Ki67%≥40、III期和皮质醇分泌与无病生存期较差相关。
结论
混合分泌皮质醇/雄激素的肾上腺皮质癌与较差的总生存期相关，而单独分泌皮质醇或雄激素的则不然。值得注意的是，在R0切除术后的患者中，分泌亚型不影响总生存期。分泌皮质醇的肾上腺皮质癌无病生存期较差。Ki67%仍然是总生存期和无病生存期较差的一个强有力的预测因素（独立于分期）。
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