肾上腺皮质癌的临床预后分析

Prognosis of Patients with Adrenocortical Carcinoma

目的探讨影响肾上腺皮质癌患者远期生存的因素,帮助临床医生判别导致患者死亡风险增高的因素,从而更好地指导临床治疗。方法经手术切除病理活检确诊为肾上腺皮质癌的患者35例,采用生存分析和Cox比例风险回归法分析影响肾上腺皮质癌患者的预后因素。结果本研究共纳入35例患者,男性20例,女性15例。其中Ⅰ期3例,Ⅱ期15例,Ⅲ期12例,Ⅳ期5例。到随访结束时死亡21例,存活14例。本组患者中位生存时间为33个月,1、2、5年生存率分别为77.1%、62.5%、38.3%。单因素分析显示:性别(男、女)、肿瘤分布(左、右)、肿瘤直径(<10cm、≥10cm)、是否有内分泌功能、是否吸烟、是否具有高血压低血钾,各组患者间生存率比较差异无统计学意义(P>0.05)。多因素分析显示:男性、年龄<50岁、早期肿瘤以及不吸烟是与生存预后相关的有益因素。晚期肿瘤患者死亡风险为早期患者的52倍,中期患者死亡风险为早期患者的3倍。结论影响肾上腺皮质癌患者远期预后的临床因素主要是临床分期和年龄。患者年龄<50岁,临床分期越早,患者的预后越好。

Objective To investigate the prognosis and influencing factors of patients with adrenocortical carcinoma.Methods Thirty-five patients（20 males and 15 females） with biopsy-diagnosed adrenocortical carcinoma were followed retrospectively.Cox proportional hazards regression analysis was performed to identify factors that influenced the prognosis of the patients.Results Three patients were classified as stage Ⅰ,15 as stage Ⅱ,12 as stage Ⅲ,and 5 as stage Ⅳ.Fourteen patients were still alive and 21 died at the end of the follow-up.The patients had a median survival time of 33 months,with a survival rate of 77.1%,62.5%,and 38.3% for the first year,second year,and fifth year respectively.The univariate analysis found no significant differences in survival rates with gender,tumor location（left or right adrenal）,diameter（≥10 cm or 10 cm） of tumor,functionality of tumor,smoking,hypertension and hypokalemia（P0.05）.The multivariate analysis revealed that being male,younger than 50 years,non-smoking and early-stage of tumor were significant protective factors for the survival of patients with adrenocarcinoma.Patients at stage Ⅲ and stage Ⅱ had 52 and 3 times higher mortality than those at stage Ⅰ,respectively.Conclusion Clinical stage and age are the main factors that influence the survival of patients with adrenocortical carcinoma.Patients younger than 50 years and those with an earlier stage of tumor would have a better prognosis.