成人肾上腺皮质癌预后因素的分析

Prognostic Determinants of Adrenocortical Carcinoma in Adults

目的探讨成人肾上腺皮质癌（ACC）的潜在预后因素。方法回顾性纳入2000年1月1日至2013年1月31日在四川大学华西医院就诊并经术后病理确诊为ACC的成年（≥18岁）患者,收集患者临床资料及术前实验室检查结果。生存率的计算采用Kaplan-Meier法,各组间生存率的比较采用Log-rank时序检验,多因素分析采用Cox比例风险回归模型。结果纳入成人ACC共52例。中位随访时间26月（3~159月）,中位生存期29月（1~156月）,1年、3年及5年生存率分别为71.0%、47.0%及42.7%。单因素分析提示年龄〉45岁（P=0.017）、分期晚（Ⅲ~Ⅳ期,P〈0.001）、未完整切除肿瘤（P=0.011）、具有临床症状（P=0.017）、合并低蛋白血症（P=0.003）及血清乳酸脱氢酶（LDH）升高（P=0.004）的患者预后差。多因素分析提示低蛋白血症（死亡风险比5.306,95%可信区间：1.975~14.258,P=0.001）、女性（死亡风险比4.020,95%可信区间：1.610~10.038,P=0.003）、肿瘤分期晚（死亡风险比7.405,95%可信区间：2.561~21.410,P〈0.001）及年龄〉45岁（死亡风险比4.628,95%可信区间：1.791~11.959,P=0.002）的患者死亡风险增加。结论术前低蛋白血症、女性性别、年龄〉45岁及肿瘤分期晚是成人ACC预后的独立危险因素。

Objective To investigate the clinical features and prognostic determinants of adrenocortical carcinoma（ACC）in adult patients.Methods All adult patients（aged≥18years old）who were admitted to West China Hospital,Sichuan University from 1st Jan.,2000 to 31st Jan.,2013 with a pathologically diagnosed ACC were included in this study.Data about the demographics,clinical characteristics,laboratory examinations and outcomes of those patients were extracted and analyzed.Results A total of 52 cases were identified,with a median follow-up of 26months（3-159months）.The patients had a median survival time of 29 months（1-156 months）,with a 1-year,3-year,and 5-year survival rate of 71.0%,47.0%,and 42.7%,respectively.In the univariate analysis,aged 〉45years old at diagnosis（P=0.017）,advanced stage（Ⅲ-Ⅳ stage,P〈0.001）,incomplete resection（P =0.011）,symptomatic（P =0.017）,hypoalbuminemia（P =0.003）,and elevated lactate dehydrogenase（LDH）（P =0.017）were associated with poor prognosis of ACC.The multivariate analysis confirmed that hypoalbuminemia〔hazard ratio（HR）=5.306;95% confidence interval（95%CI：1.975,14.258;P=0.001〕,female（HR=4.020;95%CI：1.610,10.038;P=0.003）,advanced stage（HR=7.405;95%CI：2.561,21.410;P〈0.001）,and older age（HR=4.628;95%CI：1.791,11.959;P=0.002）were predictors of poor prognosis of ACC.Conclusion Hypoalbuminemia,female,older age,and advanced stage are independent risk factors associated with poor prognosis of ACC in adult patients.