Ohsugi Haruyuki, Takizawa Nae, Nakamoto Takahiro, Mishima Takao, Uchida Katsunori, Kinoshita Hidefumi
Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan.
Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan.
Int J Endocrinol Metab. 2025 Apr 30;23(2):e159772. doi: 10.5812/ijem-159772.
Adrenocortical carcinoma (ACC) is a very rare and aggressive disease with limited systemic therapeutic options.
Treatment with adjuvant mitotane is common after resection of ACC; however, high-risk patients often experience early recurrence. The risk factors for recurrence after surgery were analyzed in patients with non-metastatic ACC.
We retrospectively reviewed the medical records of 20 patients who were treated for ACC between 1994 and 2023 at Kansai Medical University Hospital or Kansai Medical University Medical Center in Osaka, Japan. We studied the recurrence-free survival (RFS) rates of a subset of 15 patients with non-metastatic ACC [European network for the study of adrenal tumors (ENSATs) stage I-III]. Statistical analyses included the Kaplan-Meier survival analysis and the Cox proportional hazard model.
Of the 15 patients with non-metastatic ACC, nine patients (60%) experienced recurrence. The median RFS was seven months, and all recurrences occurred within 24 months. In all cases, the site of recurrence was the lungs or liver. Univariate analysis showed that ENSAT stage III classification [hazard ratio (HR) 6.974, P = 0.007] was the only factor that made a statistically significant difference to RFS. Although five of the six ENSAT stage III patients took adjuvant mitotane, all experienced recurrence.
In patients with non-metastatic ACC, a diagnosis of ENSAT stage III is the only factor that significantly affects RFS. In these patients, adjuvant mitotane is likely insufficient to prevent recurrence.
肾上腺皮质癌（ACC）是一种非常罕见且侵袭性强的疾病，全身治疗选择有限。
ACC切除术后辅助使用米托坦治疗很常见；然而，高危患者常出现早期复发。分析了非转移性ACC患者术后复发的危险因素。
我们回顾性分析了1994年至2023年期间在日本大阪的关西医科大学医院或关西医科大学医学中心接受ACC治疗的20例患者的病历。我们研究了15例非转移性ACC患者（欧洲肾上腺肿瘤研究网络（ENSAT）I - III期）亚组的无复发生存（RFS）率。统计分析包括Kaplan - Meier生存分析和Cox比例风险模型。
15例非转移性ACC患者中，9例（60%）出现复发。RFS的中位数为7个月，所有复发均发生在24个月内。所有病例中，复发部位均为肺或肝。单因素分析显示，ENSAT III期分类（风险比（HR）6.974，P = 0.007）是唯一对RFS有统计学显著差异的因素。尽管6例ENSAT III期患者中有5例接受了辅助米托坦治疗，但均出现复发。
在非转移性ACC患者中，ENSAT III期诊断是唯一显著影响RFS的因素。在这些患者中，辅助米托坦可能不足以预防复发。
