手术联合辅助性化疗治疗孤立性肺癌肾上腺转移瘤的疗效分析

Efficacy of surgical treatment combined with chemotherapy for isolated metastatic adrenal carcinoma after lung cancer

目的对于孤立性肾上腺转移瘤的治疗现仍存在争议。传统研究认为其不可治愈,但有研究报道表明手术切除孤立的肾上腺转移瘤能够延长患者的生存时间。本研究旨在探讨手术联合化疗治疗孤立性肺癌肾上腺转移瘤的临床疗效。方法回顾性分析解放军第169医院和南华大学附属第一医院2005年6月至2010年9月22例于原发肿瘤完整切除后发现并手术切除孤立性肾上腺转移瘤患者的临床资料,术后给予辅助性化疗,其中男性19例,女性3例。诊断为肾上腺同时转移的10例,异时12例。22例患者中9例接受腹腔镜肾上腺切除术,13例接受了开放的肾上腺切除术。结果中位随访时间为31.5个月,22例患者的2年及5年总生存率分别为68.7%和18.2%。其中转移瘤出现间期(DFI)大于6个月的异时转移的患者其总生存率明显好于小于6个月或同时转移的患者(35.6%vs0.0%,P<0.001)。对比开放手术,腹腔镜肾上腺转移瘤切除并不会增加患者局部复发、切缘阳性的风险。结论手术联合化疗治疗肺癌肾上腺转移疗效肯定,尤其是对于6个月以后再复发的患者疗效较好。

Objective Management of isolated metastatic adrenal tumor is still a debate. Although its incurable intent, some studies have shown that surgical treatment might improve long-term survival. The aim of this study was to show our experience about the surgical treatment of the solitary adrenal metastasis. Methods From June 2005 to September 2010, 22 patients received complete resection of the isolated adrenal metastasis after surgical treatment of lung cancer. There were 19 men and 3 women. The diagnosis of adrenal metastasis was synchronous in 10 patients and metachronous in 12 patients. Of the 22 patients, 9 patients underwent laparoscopic adrenaleetomy （LA） and 13 received open adrenalectomy （OA）. Results The median follow-up of this cohort of patients was 31.5 months. The overall 2- and 5-yr survival was 68.7% and 18.2%, respectively. In addition, patients with disease-free interval （DFI） 〉 6 months had significant higher 2-yr overall survival rate than those with DFI 〈 6 months （35.6% vs 0.0%, P〈0.001）. Meanwhile, comparing the two operation methods （LA and OA）, there was no significant difference in local recurrence, margin status, disease-free or overall survival. Conclusions Surgical treatment combined with chemotherapy was an effective treatment strategy for isolated metastatic adrenal carcinoma after lung cancer, especially those with DFI longer than 6 months.