晚期肾上腺皮质癌诊疗的临床分析

The diagnosis and treatment of advanced adrenocortical carcinoma

目的 分析晚期肾上腺皮质癌的诊断和治疗.方法 评估2002 年1 月至2014 年5 月本院泌尿微创中心收治的10 例晚期肾上腺皮质癌患者的临床数据,其中,男5 例,女5 例.结果 患者平均年龄为53.3 岁（31 ～ 85 岁）,肿瘤最大直径为（14.4±5.1）cm.10 例患者中9 例行开放手术治疗,其中6 例达到肿瘤完全切除.所有患者均为临床Ⅳ期,其中T4N1M1 4 例,T4N1M0 3 例,T3N1M0 2 例,T4N0M0 1 例.随访3 ～ 18 个月,患者平均生存期为7.5 个月,1 年总体生存率为22.2%,2 年总体生存率为0.0%.3 例患者术后行联合化疗,但并未观察到明显的治疗效果.结论 肾上腺皮质癌是-种罕见的恶性肿瘤,晚期肾上腺皮质癌临床预后极差.对于晚期肾上腺皮质癌手术方式应优先选择开放手术.值得注意的是手术难度和术中出血风险较大,患者预后较差,应结合临床实际情况谨慎把握手术指征.

Objective To investigate the diagnosis and treatment of patients with advanced adrenocortical carcinoma. Method 10 patients diagnosed with advanced adrenocortical carcinoma from January 2002 to May 2014 were evaluated. The clinic opathological data of 10 cases of advanced adrenocortical carcinoma were retrospectively analyzed, including 5 men and 5 women. Result The average age was 53.3 years, ranged from 31 to 85 years, with the tumor diamer of(14.4±5.1) cm. 9 cases of them were under open surgery, 6 cases of them underwent complete resection. All of them was stage Ⅳ. There was 4 cases of stage T4N1M1, 3 cases of stage T4N1M0, 2 cases of stage T3N1M0 and 1 case of stage T4N0M0. The mean survival time was 7.5 months after the follow up from 3 to 18 months. The overall survival rates were 22.2% in first year and 0.0% in second year. Although chemotherapy was given in 3 of them, no significant response was observed. ConclusionAdrenal cortical carcinoma is a rare malignant neoplasm with poor prognosis, especially in advanced cases, the open operation is the best way for patients of advanced adrenocortical carcinoma. The surgery is difficult, with high risk of bleeding and very poor prognosis, so the indications for surgery need to be treated carefully.