适合手术治疗的肾上腺无功能瘤直径切点探讨

Exploration of the optimal diameter cut-off value in patients with nonfunctional adrenal tumor suitable for surgery

目的分析临床诊断为肾上腺无功能瘤（NFA）患者的术后病理结果，探讨其适合手术治疗的瘤体直径最佳切点。方法收集1996年2月至2016年1月在解放军总医院内分泌科评估为NFA、同时于本院泌尿外科手术治疗且资料齐全的243例患者的临床资料。根据病理结果是否真正需要手术治疗分为需要手术组（57例）和无需手术组（186例），分析两组患者一般情况、病理类型、肿瘤直径和影响判断NFA是否需要手术治疗的因素，绘制NFA直径ROC曲线，获得灵敏度与特异度之和最大的手术最佳切点。结果s7例需要手术的患者中，男27例、女30例，瘤体位于右侧31例、左侧25例、双侧1例，直径中位数为4．5cm，就诊年龄18-71（41．5±12．1）岁。186例无需手术组中，男87例、女99例，瘤体位于右侧99例、左4N86例、双侧1例，直径中位数为3．0cm，就诊年龄13～76（50．6±10．9）岁。Logistic回归分析示瘤体直径可能是肾上腺无功能瘤需要手术的危险因素（OR=1．340，95％CI1．266～1．418，P=0．000），年龄可能是保护因素（OR=0．942，95％CI 0．929～0．955，P=0．000）。ROC曲线下面积（AUC）为0．757（95％CI 0．681-0．833），以瘤体直径4．1cm作为NFA手术切点时，Youden指数最大（灵敏度60．7％，特异度83．0％）。结论NFA直径较大的年轻患者需要采取手术治疗的可能性较大。以直径4．1cm作为NFA患者的手术切点最佳。

Objective To analyze the pathology of the patients with nonfunctional adrenal tumor （NFA）, and explore the optimal diameter cut-offvalue. Methods The clinical data of 243 patients with NFA, evaluated in the Department of Endocrinolo- gy and operated in the Department of Urology of General Hospital of Chinese PLA from Feb. 1996 to Jan. 2016, were collected. The patients were divided into two groups according to pathology： those in real demand of surgery were classified to the surgery-need group （n=57）, while the others were categorized as the surgery-unwanted group （n=186）. The general situation, pathological type and tumor diameter of the two groups and the factors affecting the surgery were analyzed, and the ROC curve was used to explore the optimal surgery cut-off value, which represents the maximum value of the sum of sensitivity and specificity. Results Of the 57 patients in surgery-need group （27 males and 30 females）, the lesions were on the right in 31 cases, on the left in 25 cases, and on bi- lateral sides in 1 case; the median of lesion diameter was 4.5cm, and the average age was 41.5 ± 12.1 years old. Of the 186 patients in surgery-unwanted group （87 males and 99 females）, the lesions were on the right in 99 cases, on the left in 86 cases, and on bilateral sides in 1 case; the median of lesion diameter was 3.0cm, and the average age was 50.6 ± 10.9 years old. Logistic regression revealed that lesion diameter might be a risk factor （OR=1.340, 95%CI 1.266-1.418, P=0.000） and age be a protective factor （OR=0.942, 95%CI 0.929-0.955, P=0.000） for real demand of surgery. The area under the ROC curve （AUC） of lesion diameter was 0.757（95%CI 0.681-0.833）. The optimal cut-offvalue was 4.1cm （sensitivity 60.7% and specificity 83.0%）. Conclusions Younger patients with bigger lesion diameter may have greater possibility for surgery. The optimal surgery cut-off value of the lesion diameter is 4. lcm.