Collichio F A, Woolf P D, Brower M
Medical Oncology Unit, Strong Memorial Hospital, Rochester, New York.
Cancer. 1994 Mar 1;73(5):1361-7. doi: 10.1002/1097-0142(19940301)73:5<1361::aid-cncr2820730509>3.0.co;2-j.
Small cell carcinoma (SCC) associated with clinical evidence of tumor corticotropin (ACTH) production is common, and management of this syndrome is difficult. The purpose of this retrospective analysis is to describe clinical features, prognosis, and treatment results in patients with SCC and the syndrome of ectopic ACTH secretion to permit formulation of management guidelines for these patients.
Using tumor registry data and chart review, the authors identified patients with SCC and ectopic ACTH secretion treated over 11 years at two large teaching hospitals. They recorded clinical and laboratory data regarding the patients' tumors and their endocrine syndrome along with results of treatment for the malignancy and the hypercortisolism.
Ten patients with SCC and ectopic ACTH secretion were identified. These patients were initially seen with adverse prognostic features, including elevations of serum lactate dehydrogenase and extensive stage disease. Cytotoxic chemotherapy and standard doses of anti-adrenal medications rarely controlled the paraneoplastic syndrome. Bacterial or opportunistic infections, although not neutropenic, developed in most patients. Median survival of patients diagnosed with the paraneoplastic syndrome at the same time as the initial diagnosis of cancer was 4 months. However, three patients whose cortisol secretion was controlled survived longer than 6 months.
Patients with SCC and ectopic ACTH syndrome have a poor prognosis. However, in the minority of patients whose hypercortisolism can be controlled with cytotoxic chemotherapy combined with treatment to inhibit cortisol biosynthesis, effective palliation can be achieved.
与肿瘤促肾上腺皮质激素（ACTH）分泌临床证据相关的小细胞癌（SCC）很常见，且该综合征的管理困难。这项回顾性分析的目的是描述SCC患者及异位ACTH分泌综合征的临床特征、预后和治疗结果，以便为这些患者制定管理指南。
作者利用肿瘤登记数据和病历审查，确定了在两家大型教学医院接受治疗超过11年的SCC和异位ACTH分泌患者。他们记录了有关患者肿瘤及其内分泌综合征的临床和实验室数据，以及恶性肿瘤和皮质醇增多症的治疗结果。
确定了10例SCC和异位ACTH分泌患者。这些患者初诊时具有不良预后特征，包括血清乳酸脱氢酶升高和广泛期疾病。细胞毒性化疗和标准剂量的抗肾上腺药物很少能控制副肿瘤综合征。大多数患者发生细菌或机会性感染，尽管不是中性粒细胞减少性感染。与癌症初始诊断同时被诊断为副肿瘤综合征的患者中位生存期为4个月。然而，3例皮质醇分泌得到控制的患者存活时间超过6个月。
SCC和异位ACTH综合征患者预后较差。然而，在少数可以通过细胞毒性化疗联合抑制皮质醇生物合成的治疗来控制皮质醇增多症的患者中，可以实现有效的姑息治疗。
