成人肾上腺皮质癌预后的影响因素分析

Prognostic Predictors of Adrenocortical Carcinoma in Adults

【目的】探讨影响成人肾上腺皮质癌(ACC)预后的潜在因素。【方法】回顾性收集2011年12月至2017年3月在中山大学孙逸仙纪念医院就诊并经病理确诊的成人ACC患者,主要收集患者的临床资料及术前实验室检查结果。采用Kaplan-Meier法绘制生存曲线及计算中位生存时间和平均生存时间,采用Log-rank检验比较各组间生存率差异,采用单因素及多因素Cox回归模型计算风险比(HR)及95%置信区间(95%CI)。【结果】纳入成人ACC患者20例。中位随访时间13个月(6～73个月),平均生存时间49.2个月(6～73个月),1年总生存率为70.0%。Cox多因素分析结果提示合并皮质醇高分泌(HR=14.53,95%CI:1.11-190.80,P=0.042)、低钾血症(HR=23.60,95%CI:2.49-223.79,P=0.006)的ACC患者预后不良。此外,在18例行根治性切除术的患者中,多因素分析结果提示合并低钾血症(HR=6.45,95%CI:1.41-29.54,P=0.016)的患者肿瘤复发风险增加。【结论】合并皮质醇高分泌、低钾血症是影响成人ACC预后的独立危险因素。

【Objective】To analyze the prognostic determinants of adrenocortical carcinoma(ACC)in adults.【Meth.ods】All adult patients who were admitted to Sun Yat-sen Memorial Hospital,Sun Yat-sen University from December 2011 to March 2017 and pathologically diagnosed ACC were included in this study.The clinical data and preoperative lab.oratory examinations of those patients were analyzed retrospectively.Overall survival or disease-free survival was calculat.ed and survival curves were plotted by Kaplan-Meier and compared by log-rank test.Harzard ratios(HRs)with their 95%confidence intervals(CIs)were calculated by univariate and multivariate Cox regression model.【Results】The study included 20 adult patients with ACC,with a median follow-up of 13 months(6~73 months).The mean survival time of those patients was 49.2 months(6~73 months),with a 1-year survival rate of 70.0%.The results of multivariate Cox re.gression analysis revealed that the presense of cortisol hypersecretion(HR=23.60,95%CI:2.49-223.79,P=0.006)and hypokalemia(HR=23.60,95%CI:2.49-223.79,P=0.006)were predictors of poor prognosis of ACC.Moreover,in 18 patients with completely resected ACC,the presense of hypokalemia resulted in a worse disease-free survival.【Conclu.sion】The presense of cortisol hypersecretion and hypokalemia are independent risk factors associated with poor prognosis of ACC in adults.