肾上腺皮质癌手术治疗体会及预后分析

Clinical experience and prognosis of surgery for patients with adrenal cortical carcinoma

目的:本文主要探讨肾上腺皮质癌(ACC)的临床诊治特点及影响患者预后的相关因素。方法:回顾性分析2006年1月~2016年10月我院收治的35例ACC患者的相关临床资料并进行了术后随访。结果:33例患者行手术治疗,其中4例患者仅行减瘤手术,其余患者均完整切除肿瘤。行减瘤手术患者均于术后14个月内死亡,平均存活12.5个月。所有患者中获得随访者30例,失访者5例,随访时间10~119个月,平均39.7个月。结果分析显示死亡组与生存组在除性别及手术时间外的年龄及平均住院日等指标上差异均无统计学意义(P>0.05);肿瘤预后的单因素Cox回归分析显示:患者手术方式、Ki-67指数、肿瘤直径等指标对患者的预后无影响(P>0.05),肿瘤分期和肿瘤切除方式对患者预后有影响(P<0.05)。结论:对于ACC患者选择手术治疗时,具体的手术方式应结合具体情况而定,肿瘤分期越早行手术治疗后预后越好,肿瘤完整切除的患者预后好于仅行减瘤手术的患者。

Objective：To investigate the clinical effect and prognosis of surgery for patients with adrenal cortical carcinoma（ACC）.Method：A retrospective review was performed on 35 patients who were diagnosed with ACC from 2006 to 2016 at Tongji Hospital and all their clinical data were included.Result：Among 35 cases,33 cases had chosen the adrenal tumor resection,of which 4 cases underwent partial resection and the rest cases were completely resected.All the 4 patients died in 14 months after surgery and the mean survival after surgery of them was12.5 months.There were 30 cases who had been followed up successfully and the postoperative follow-up period ranged from 10 to 119 months.The mean postoperative follow-up period was 39.7 months.The analysis of the clinical data showed that there existed no statistical difference in sex,age,and average length in hospital of patients（P〉0.05）.The univariate regression analysis showed that different surgical methods,Ki-67 proliferating index and diameter of tumor were not statistically significant（P〉0.05）,but tumor staging and surgical ways of tumor resection were statistically significant（P〈0.05）.Conclusion：For the patients with ACC,how to choose the correct surgical method depends on every single patient＇s specific condition.The tumor staging is the most significant prediction factor of patients with ACC.The prognosis of patients with en-bloc resection is better than that of patients with partial resection.