肾上腺转移癌37例临床分析

Metastatic tumors of the adrenal glands (Report of 37 cases)

目的 :探讨肾上腺转移癌的临床特征 ,以祈得到及时诊治。方法 :回顾性分析 37例肾上腺转移癌的临床资料 ,2 6例于诊断原发肿瘤之后发现 ,4例于诊断原发肿瘤的同时发现 ,7例于诊断原发肿瘤之前发现。 5例有局部压迫或疼痛症状。 11例为双侧肾上腺转移癌 (2 9.7% )。 4例肾上腺转移癌经手术切除 ,31例采用化疗、放疗或免疫治疗 ;2例未作处理。结果 :16例 (4 3.2 % )为肺癌肾上腺转移 ,7例 (18.9% )为肾癌 ,5例 (13.5 % )为乳癌 ,3例 (8.1% )为胃癌 ,2例 (5 .4 % )为结肠癌 ,肝癌、胆管癌、甲状腺癌、绒毛膜上皮癌各 1例 (均为 2 .7% )。经手术切除者平均生存期为 (17.5± 2 .9)个月 ,比非手术者的平均生存期稍长 (P <0 .0 5 )。结论 :对肾上腺转移癌应争取早诊断 ;对未发现其他器官或淋巴结转移的孤立性肾上腺转移癌 ,应尽可能行积极的外科手术 ;对于原发肿瘤已无法完全切除或已多处转移者 ,应争取行放、化疗或免疫治疗。

Objective:To review the clinical records and pathological features and to evaluate the diagnosis and management of adrenal metastases.Methods:Thirty seven cases with metastatic disease in the adrenal glands were analyzed retrospectively in inpatients. Many of the metastatic lesions in the adrenal gland occurred shortly after the detection of a primary tumor. 13.51% of the adrenal lesions were symptomatic. The adrenal metastases were bilateral in 29.7% of the patients. 10.8% of the adrenal metastases were surgically removed. 83.78% of the adrenal metastases received adjuvant therapy.Results:Lung was the most common primary tumor site ( 43.2%), followed by the renal cell carcinoma ( 18.9%), breast cancer ( 13.5%), stomach cancer ( 8.1%), colonic carcinoma ( 5.4%), liver cancer ( 2.7%), bile ducts cancer ( 2.7%), thyroid cancer ( 2.7%), chorionic epithelioma ( 2.7%), respectively. The median survival of the 4 patients with surgically removed was 17.5± 2.9 months after the detection of adrenal metastases. Patients with surgically removed adrenal metastases had better survival rates than those without surgical resection(P< 0.05).Conclusions:In case of demonstration of metastatic involvement the patient could be spared a useless resection of the primary tumor. However, aggressive surgery could still be considered and Long-term survival may be achieved in selected patients.